Eagle Scout Certificate
Request Form

EAGLE SCOUT RECOGNITION CERTIFICATE

The Allentown Diocese Catholic Committee on Scouting is pleased to offer the Scouts in the Diocese of Allentown, who have attained the rank of Eagle Scout, a congratulatory certificate of recognition. To ensure the congratulatory certificate of recognition is prepared in proper format, please use ALL CAPITAL LETTERS for the First Name, Middle Initial, Last Name, and Street and City when completing the request form below.

A parent, troop leader, or legal guardian can make a request on behalf of a Scout who has achieved the rank of Eagle Scout. The Congratulatory Certificate of Recognition will be mailed to the address you provide; however, if you do not want the scout to personally receive the certificate in advance of his Eagle Court of Honor, the address may be of a parent, troop leader, or legal guardian.

If possible, we would like to personally present the certificate at the Eagle Scouts Court of Honor if we have someone available to do so. If we do not, we will mail the certificate to the person designated below in the request form.

Please allow ample time for the ADCCOS to respond and send out your certificate. Certificate requests will be handled as soon as possible, but you should allow for at least a 3-4 week waiting period.

Please complete the fields below to request your certificate

ALL Fields are Required

EAGLE SCOUT INFORMATION:
Eagle Scout Name:  (as it will appear on certificate)
Unit Number:
Scoutmaster:
Council/District:
Parish:
Date on Certificate: (MM/DD/YYYY)  (within the last two years)

Religious Emblems Awarded and Year:
Light of Christ    Year:
Parvuli Dei         Year:
Ad Altari Dei      Year:
Pope Pius XII     Year:
None

CERTIFICATE REQUESTOR INFORMATION:
Requestor Name:
Requestor Address:

Requestor Phone Number: (XXX) XXX-XXXX:
E-mail address that you check often:

CERTIFICATE DESTINATION INFORMATION:
Mail to Name: 
Mail to Address:


EAGLE SCOUT COUR OF HONOR INFORMATION (Date, Place & Time):


EAGLE SCOUT PROJECT DESCRIPTION:
Eagle Scout Project description (Briefly):

Please review and verify all information before pressing Submit!
Check this box AFTER you have CONFIRMED ALL information to be submitted
If the information cannot be verified or confirmed, the certificate will not be sent.