Central Region Jewish Committee on Scouting

CHAI Award Application

Instructions: Please print out this page and neatly print the information requested. The

Award Nomination form should be signed by the local council Scout Executive, the local

Council JCoS chairman and another member of the committee. Please mail or email

(PDF) the application at least thirty (30) days prior to the Central Region JCoS

Conference (www.jewishscouting.org for additional information) to:

Michael Miller, CRJCOS Conference Chairman

9416 Est 14^th Street, St. Louis Park,MN 55426

Email: mdmiller@q.com

Person being nominated

Nominee's Name: ______________________________________________________

Nominee's Mailing Address: __________________________________________

City, State, ZIP: ____________________________________________________

Nominee's Scout Council:______________________________________________

Nominee's Current Position in Scouting: ______________________________

I nominate this person for the [ ] Bronze, [ ] Gold, [ ] Silver Award

Person making the nomination

Nominator's Name: _____________________________________________________

Nominator's Mailing Address: __________________________________________

City, State, ZIP: _____________________________________________________

Nominator's Phone #: (________) _______________________________________

Nominator’s Email: ____________________________________________________

Approvals

   Council Scout Executive: ___________________________ Date: ____________

Council JCoS Chairman: _____________________________ Date: ____________