Northern Trail District

Your Extordinary Service Award Nomination Form

This award recognizes individuals in units who have preformed extraordinary service to their units. Every Unit receives 2 nominations, units that have 50-99 youth members are entitled to an additional nomination, and Units with 100 or more youth members are allowed a total of 4 nominations.

Any adult member of a unit may make a nomination, but it's best to check with your unit chair.

Name of Nominee

Please insure that the name is spelled correctly with the correct capitalization. It will be included on the certificate exactly as you enter the information.

Unit Type

Please indicate the unit type and number.

Nominee Position

Please indicate the position of the nominee in the unit. For example Den Leader, merit badge counselor, cubmaster etc.

Unit Chartering Organization

Please indicate the name of the chartering organization for the nominee's unit.

Your Name

Please provide your name.

Your Position in Unit

Please provide your position in your unit. For example, member of the committee, den leader, cubmaster, etc.

Your Email Address

Please provide your email address so we can contact you about the nomination.

Recipient's Email Address

Please provide the nominee email address so we can contact them should the nomination be approved.

Statement about Nominee

Please provide a statement about why this person should receive this award. Your statement will be included in the awards banquet program. Please be concise, we have limited space in the program.


Enter the code shown in the blue box. This is necessary to reduce abuse of the site by malicious users.
Enter this number: here:

Check your work carefully and then hit the Submit Nomination button below.

Be sure and enter the 4 digit captcha, if you don't, you will lose your work. I recommend that you compose your statement offline and then paste into the box.

You should see a confirmation page and receive an email if the submission was successful.