Identification Information
Last Name
First Name
Introductory Training
Fast Start Video
Youth Protection Training (YPT)
No
Yes
No
Yes
If yes, when completed (month & year)?
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
N/A
Year
N/A
1999
2000
2001
2002
2003
2004
Scout Leader Training
New Leader Essentials
If yes, when completed (month & year)?
No
Yes
Month
N/A
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
N/A
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Scoutmaster & Assistant Scoutmaster Training
If yes, when completed (month & year)?
No
Yes
Month
N/A
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
N/A
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Troop Committee Member Training
If yes, when completed (month & year)?
No
Yes
Month
N/A
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
N/A
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Introduction to Outdoor Leader Skills
If yes, when completed (month & year)?
No
Yes
Month
N/A
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
N/A
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Scout Adult Leader Training (SALT)
SALT was replaced by the Scout Leader Training mentioned
above. Anyone who completed SALT within the past 5
years is deemed to be trained.
If yes, when completed (month & year)?
No
Yes
Month
N/A
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
N/A
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Special Training
Safety Afloat & Swim Defense
If yes, when completed (month & year)?
No
Yes
Month
N/A
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
N/A
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Backpack Awareness Training
This used to be call High Adventure Training (HAT). If
you completed HAT, click yes and indicate when you completed
the training.
If yes, when completed (month & year)?
No
Yes
Month
N/A
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
N/A
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
CPR & First Aid Training
If yes, when completed (month & year)?
No
Yes
Month
N/A
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
N/A
2001
2002
2003
2004
Driver Information
Name
(exactly as on driver's license)
Driver's License Number
Automobile Make
Automobile Kind
Model Year
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Other
Automobile Insurance
Public liability (each person) $50,000
Public liability (each accident) $100,000
Property damage $100,000
-or-
Combined single limit $100,000
I have automobile insurance equal to or exceeding the
amounts specified.
No
Yes
Submit
Please submit just one time. You should receive a
confirmation when you do so.