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:* Date Format: MM slash DD slash YYYY Current Grade:*6789101112High School Name:*Graduation Date:* Date Format: 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:Captcha
