Application Form For s1

Leaders Medal Of Achievement Completion Form

Please submit this form to the district training coordinator upon earning the Leaders Medal of Achievement (LMA). Also, please photocopy any certificates of completion from modules you’ve attended and include them in the envelope with this printed form. If you don’t have the certificate and/or can’t remember the exact date you attended a module please type the approximate month/year.

PLEASE USE A COMPUTER TO TYPE YOUR INFORMATION THEN PRINT

Name:

Address:

City: State: Zip: District:

Phone: () Email Address:

Church: Outpost Number:

Number of year’s involvement as a commander in Royal Rangers:

Please check all training modules/events completed:

Required Modules

Ranger Basics Date Attended: Location:

Discipleship I Date Attended: Location:

Discipleship II Date Attended: Location:

Safety and the Church Date Attended: Location:

Successful Outposts Date Attended: Location:

*LTA Campout Date Attended: Location:

*Ranger Kids Skills Date Attended: Location:

**RK Activities Date Attended: Location:

**DR/AR Activities Date Attended: Location:

**ER Activities Date Attended: Location:

*Note: The LTA Campout, RK Skills, NTC, BSTC, or RKTC may be used to satisfy this requirement.

**Note: Only 1 activities module is required

Elective Modules (1 Required)

ANTC Date Attended: Location:

BSTC Date Attended: Location:

Outpost Chaplain Date Attended: Location:

Child / Substance Abuse Date Attended: Location:

Classroom Management Date Attended: Location:

DLTC Date Attended: Location:

FCF Date Attended: Location:

How to Start an Outpost Date Attended: Location:

NCE Date Attended: Location:

NTC Date Attended: Location:

NTT Date Attended: Location:

Outpost Council Date Attended: Location:

Patrol Method Date Attended: Location:

Presentation Skills Date Attended: Location:

RKTC Date Attended: Location:

Royal Ranger Data Manager Date Attended: Location:

Senior Commander Date Attended: Location:

WNTC Date Attended: Location:

Working with Boys with Date Attended: Location:

Disabilities

Required Non-LTA Training

First Aid / CPR Date Attended: Location:

I am a Royal Rangers commander serving in a chartered outpost. The information stated above is accurate to the best of my knowledge.

Date:
Applicant’s Signature

Mail printed application to: District Training Coordinator