Boy and Girl Scout NASA Recognition Request Application

To ensure the Congratulatory Letter and Certificate of Recognition are prepared in proper format, please use initial capitalization for the first letter of the First Name, Middle Initial, Last Name, and Street and City.

A parent, troop leader, or legal guardian can make a request on behalf of a scout who has achieved the rank of Eagle Scout or Gold Awardee. The Congratulatory Letter and Certificate of Recognition will be mailed to the address listed below - this can be the address of a parent, troop leader, or legal guardian if you do not want the scout to receive the certificate and letter directly.

Request Form

Fields with * are required.

Name of Scout*

*Recipient must be at least 13 years of age

Title:	Mr.* Ms. *
First Name:	* Example: John
Middle Initial:	Example: A
Last Name:	* Example: Smith
Suffix:

Address to which the Congratulatory Letter and Certificate of Recognition will be mailed:

Address:	* Example: 135 Potomac Drive or 234 DuVall Street
Address 2:
City:	* Example: Springfield
State:	*
ZIP Code:	*

Contact Information of Requester:*
*This information is requested in order to allow for verification of the above information to ensure the certificate and letter are printed accurately.

E-mail:	*
Telephone Number:	* Example: (123)456-7890 or 123-456-7890

By submitting this request, I am acknowledging that the designated scout: - has achieved the level of Eagle Scout or Gold Award, - is 13 years or older, and - I am the parent, legal guardian, or troop leader of the designated scout. Privacy Policy This notice provides NASA's policy regarding the nature, purpose, use and sharing of any information collected via this Web site. The information you provide on a NASA Web site will be used only for its intended purpose. We will protect your information consistent with the principles of the Privacy Act, the e-Government act of 2002, the Federal Records Act, and as applicable, the Freedom of Information Act. Submitting information is strictly voluntary. By doing so, you are giving NASA your permission to use the information for the intended purpose. If you do not want to give NASA permission to use your information, simply do not provide it. However, not providing certain information may result in NASA's inability to provide you with the information or services you desire. For additional information please visit NASA Web Privacy Policy and Important Notices