To request a City Council Certificate for a Boy Scout receiving the Eagle Scout Award, please complete this form and return to the City Manager’s Office. Awards are available to residents of the City of Thousand Oaks.

1

Scout Information

Scout Information

Scout's First and Last Name

Scout Troop

2

Contact Person

 *

Contact Person

Name	Address
Phone	Email

3

Event Details

Event Details

Date

Time

Location

4

If their schedules allow, would you like to invite a City Council member to personally present the certificate?

 *

If their schedules allow, would you like to invite a City Council member to personally present the certificate?

Yes

No

5

If you would like a City Council member to present, please provide us with more information about the Eagle scout. (Eagle Scout Project, achievements within the City, volunteer work, etc.)

If you would like a City Council member to present, please provide us with more information about the Eagle scout. (Eagle Scout Project, achievements within the City, volunteer work, etc.)

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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