Request for Gold Award Mentor

Please allow a minimum of three weeks for a mentor to be assigned to you. You may also request a specific mentor (see below). If you have not been assigned a mentor within the about time period, please contact your regional Leadership Program Specialist.

Troop Number (Five Digits):*
Which region are you in?*
- Southeast (Arcadia & Upland)
- Southwest (Long Beach & Inglewood)
- North (Woodland Hills, Palmdale, & Santa Clarita)
Gold Award Applicant's Name:*
First Last
Phone Number:*
Email:*
Enter Email Confirm Email
Address:*
Street Address City ZIP Code
Applicant's Date of Birth:*
MM slash DD slash YYYY
Current Grade:*
High School Name:*
Graduation Date:*
MM slash DD slash YYYY
Signature of Applicant:*
Type your full name as your signature.
Please list any special requests you may have for a mentor. Mentors are selected from available volunteers outside your troop or group. A mentor will be someone other than your leader or parent and must have knowledge of the Gold Award process. Special Requests:
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GSGLA volunteer

GSGLA volunteer

Request for Gold Award Mentor