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Adult APPLICATION 2021
and leadership request form
NO COMMITMENT until accepted
We will call you when you are accepted.
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Required field
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Indicates required field
Your Formal Name
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First
Last
Name you are know by:
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Home Troop #
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Enter T-xxxx, where xxxx is your Troop Number
Main Contact Phone Number
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Can we text this number?
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YES
NO
Phone Number belongs to:
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How many years of MISST service.
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What Merit Badges do you councel?
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Your Email:
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1st Alternate Phone Number
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Can we text this number?
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YES
NO
1st Altenate Phone Number belongs to:
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2nd Alternate Phone Number
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Can we text this number?
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YES
NO
2nd Alternate Phone Number belongs to:
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Address
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Line 1
Line 2
City
State
Zip Code
Country
List any Medical, Dietary, or Food allergy we should be aware of.
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Spouse's Name
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First
Last
Spouse's Email
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Birth Date
:
Month
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January
February
March
April
May
June
July
August
September
October
November
December
Day
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1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
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Emergency Contact Name
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First
Last
Phone Number
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Can we text this number?
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YES
NO
Relationship
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Home Troop Position
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Home Scoutmaster or Committee Chair
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Phone Number
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Can we text this number?
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YES
NO
UNKNOWN
Why have you decided to participate in the Mackinac experience?
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What do you expect to gain from the experience?
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List Leadership Positions held in your home troop
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Scouting Awards
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Order of the Arrow Membership and offices
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Scouting Training (Courses taken and dates)
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List any ather Extra Curricular Activities you are involved with
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If you served at Mackinac what were the years you attended?
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Example: 2004, 2005 or 2004-2009
List Positions Held on the Island
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Check if you are you certified in:
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CPR
First Aid
The information above is required for all applying to go to Mackinac Island for this season.
Choose the one Leadership Position for which you are applying?
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Patrol Advisor
Assistant Scoutmaster
Chef
Sou Chef
Health Officer
Music Advisor
Committee Member
Why do you want to hold this position? What are you qualification?
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Choose all positions you would be willing to fill.
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Patrol Advisor
Assistant Scoutmaster
Chef
Sou Chef
Health Officer
Music Advisor
Committe Member
What are you qualifications for these positions?
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gIVE THREE REFERENCES:
1
Name
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First
Last
Phone Number
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2
Name
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First
Last
Phone Number
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3
Name
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First
Last
Phone Number
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additional information:
Make any additional comments and/or upload a more detailed letter.
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