Diocese of Brooklyn Catholic Committee on Scouting

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2016-2017 Nomination Form for The Bronze Pelican Emblem

Catholic Committee on Scouting
Diocese of Brooklyn
THE BRONZE PELICAN EMBLEM
NOMINATION FORM
.

Application Date____________________________________
(See Award Requirements before Completing Nomination)
Name of Nominee _____________________________________________________________
Address of Nominee____________________________________________ City__________________, Zip_____________
Telephone Number of Nominee:________________________________________________
1. Catholic Parish of Nominee:__________________________________________________
Parish Address_________________________________________________________________
2. Describe how the nominee has influenced the youth in Scouting which will indicate that he/ she is
a worthy candidate for the Bronze Pelican Award.  Give concrete examples:________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
3. Indicate how the nominee has promoted participation of Scouts in activities for Catholic Scouts. 
Give concrete examples.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
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4. Please provide any additional information which you believe to be pertinent as you nominate this adult for
the Bronze Pelican Emblem. __________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
5. Attach letter of recommendation from member of the Parish Staff.

Return Nomination package to:
.
Mr. Paul D. Stanton
2 Hinckley Place, Apt 1L
Brooklyn, NY  11218-3353

(Date Form Received____________ Parish Letter__________ Award Payment___________ )