OFFICE USE ONLY Issue Date: Return Date Rating/Score

REPRESENTATIVE DEMOLAY EVALUATION FORM

Please print

Full Name _________________________________ Chapter Name _______________________

Member ID Number _________________________ Chapter Number _____________________
Address ______________________________ City___________________ State ____ Zip_____
Phone Number (_____)____________________ Email ________________________________

Congratulations! You have taken the first step toward becoming a Representative DeMolay,
which is one of the most challenging awards a DeMolay can earn. The form itself is not
challenging to fill out. It is challenging to be completely honest about yourself when you are
working on the form. Remember, that honesty is the key! The purpose of this evaluation is to
help you discover those areas in which you have strength and also those that you should
strengthen. This is why you are required to give a Personal Rating in each area to become a
Representative DeMolay.
You do not have to be a Master Councilor or have the Blue Honor Key to receive the
Representative DeMolay Award. However, you will not receive the Representative DeMolay
Award if you are not honest and thorough when reporting your DeMolay accomplishments.

INSTRUCTIONS
1.) Use a typewriter if at all possible. Otherwise, PRINT in Black or Blue Ink. Forms
written in pencil or another color ink will be returned.
2.) Any statements or other material attached with this form should be stapled or fastened to
it with a clip, and no attachment materials should be larger than 8 ½ x 11 inches.
3.) Copies may and should be submitted in place of originals, as no materials will be
returned to the applicant.
4.) A Senior DeMolay who submits this form should answer all questions applicable to him.
In addition, he should attach a brief statement showing what services he has rendered to
the Order since receiving his majority. These services may be to his own Chapter or in
some larger relationship, such as jurisdictional staff.
5.) All requests meeting the Advisory Council’s approval should be signed by the
appropriate Advisors and mailed to:
Your Executive Officer or Personal Representative
6.) If the original form is spoiled, a duplicate may be obtained from the above address.
7.) When the Representative DeMolay is granted, the regalia will either be sent to your
Chapter Advisor for presentation or will be reserved for presentation at a time and place
designated by the Executive Officer (such as a jurisdictional event).
8.) Mail this form flat – Do not fold.
FILIAL LOVE
“…that love which existed before we were born, has remained with us all our life through, and will follow
us even beyond the grave.”

HOME RELATIONSHIPS
A DeMolay should have an attitude of thoughtfulness and cooperation in the home and display it
in his home relationships.

A. Who is currently living in your household? List their names and relation to you:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
B. What duties around the home are you regularly responsible for? (i.e. car care, yard work,
farm duties, contribute money to support of home, car of brothers and/or sisters, cleaning of
your room, emptying garbage, chores, etc.)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
C. Home Letter. A letter or statement MUST BE ATTACHED from one or both parents or
guardian to cover this. If your parent(s) or guardian feel your home relations have become
more satisfactory since becoming a DeMolay, their letter should state why they think so such
as improved courtesy and cooperation in the home or increased familial responsibility.

D. I would rate my self in this area as:

 Excellent Above Average Average  Fair  Needs Improvement

REVERENCE FOR SACRED THINGS

“A young man crossing the threshold of DeMolay for the first time professes a deep and abiding faith in one living
and true God.”

RELIGIOUS IDEALS
A DeMolay should appreciate the importance of religious ideals and the value of the Holy
Place of Worship, both to society in general and as a means of cultivating and expressing
religious ideals in his own life.
 A. What has influenced you in determining your religious beliefs?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

B. To what, if any, church do you belong/attend? ___________________________________

C. State the approximate number of times you have attended during the past year:
Regular Worship Services ________ Sunday School _________ Youth Group___________
Other religious services (state what) _____________________________________________

D. Describe your religious participation (usher, choir, offices, conferences, retreats, youth
society, volunteer work, church groups, etc.) ______________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

E. Approximately how much time do you spend each week reading the Bible or other
religious writings? ________________________________________________________

F. Letter from a Religious Leader. A letter or statement from your religious leader may be
attached to aid in the evaluation of this form. If your religious leader feels that your devotion
to God has improved or deepened as a result of your membership in DeMolay, his/her letter
should state so.

G. I would rate my self in this area as:

 Excellent Above Average Average  Fair  Needs Improvement

ENVIROMENTAL PRESERVATION
A DeMolay should have an appreciation of nature and an understanding of the importance of a
clean and healthy environment.
A. Explain briefly why you think nature preservation is important:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
B. In what ways does nature relate to God and the DeMolay precept of Reverence for
Sacred Things? __________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
 C. What activities do you participate in to ensure that the environment will be clean and
healthy for future generations? ______________________________________________
________________________________________________________________________
________________________________________________________________________

D. I would rate my self in this area as:

 Excellent Above Average Average  Fair  Needs Improvement

COURTESY
“…a courtesy that transcends friendships, a courtesy which reaches to the stranger, to the aged, to all men.”

SELF MASTERY
A DeMolay should be able to demonstrate habits of self-control. In this section, you and your
Chapter Advisor should together rate you in each area:
A. How well do you control your temper, and in what ways do you think you can improve?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

B. My Chapter Advisor and I rate myself in this area as:

 Excellent Above Average Average  Fair  Needs Improvement

C. How would you rate your cleanness of speech (freedom from profanity) and how could
you improve the quality of your spoken words? _________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

D. My Chapter Advisor and I rate myself in this area as:

 Excellent Above Average Average  Fair  Needs Improvement

E. How courteous are you to family and friends (including Chapter members and Advisors)
both in private and public settings? __________________________________________
________________________________________________________________________
________________________________________________________________________

F. My Chapter Advisor and I rate myself in this area as:

 Excellent Above Average Average  Fair  Needs Improvement

G. Open Letter: A letter or statement from a member of your family OTHER THAN your
parents or guardians (such as grandparents, brother or sister, aunt or uncle, neighbor, etc) may be
attached to aid in the evaluation of this form. You can also ask another Chapter member or
DeMolay to write a letter for you. If this person feels that you have become more courteous
since joining the Order of DeMolay, the letter should state how so.
RESPECTING WOMANHOOD
A DeMolay should value women and demonstrate his respect for them through his words and
deeds. In this section, you and your Chapter Advisor should rate you in each area:
A. How well do you treat your mother, grandmother, sister(s), and other female family
members? How highly do you speak of them to others? Why? _____________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

B. My Chapter Advisor and I rate myself in this area as:

 Excellent Above Average Average  Fair  Needs Improvement
C. How well do you speak of women in general, both in private and public settings?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
D. In what ways do you feel that women are degraded in our society? If so, what do you do
to prevent that from occurring? ______________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

E. My Chapter Advisor and I rate myself in this area as:

 Excellent Above Average Average  Fair  Needs Improvement

COMRADESHIP
“As long as we remain faithful to these pledges, as long as there is an Order of DeMolay — we are one.”

CHAPTER ACTIVITY
A DeMolay should participate in the activities of the Order, not only in the business meetings of
his Chapter, but the social events, both at the Chapter and jurisdictional level. It is not necessary
to have held an office in the Chapter to be eligible for the Representative DeMolay award. Some
DeMolays, particularly in large Chapters, have rendered most helpful and loyal service in many
ways without ever holding office. No DeMolay will be awarded the Representative DeMolay
award unless the answers show that he may be said so to be genuinely interested in the work of
DeMolay.

A. When did you join the Order of DeMolay? ____________________________________

B. How many of your Chapter’s meetings did you attend last year? __________________
C. What percent was this of the meetings held? ___________________________________
D. Have you passed both obligations in open Chapter? ______ If so, when? ___________

E. List the Chapter offices you have held and the number of times you have held them:
 ________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

F. List the committees you have served on, projects managed, events planned, in DeMolay
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
G. List the ritual parts you have given from memory in the Initiatory Degree:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
H. List the ritual parts you have given from memory in the DeMolay Degree:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

I. List the public ceremonies you have given from memory: _________________________
________________________________________________________________________

J. Does your Chapter have a Merit Bar Program? ________ If so, please state the number
of each merit bar you have received next to the appropriate category:

Athletics Fund-raising Merit

Attendance Installing Priory
Civic Service Journalism Religion
Masonic
Conclave Attendance Ritual
Correspondence
Course Masonic Service Scholastics
Fine Arts Membership Visitation

K. How many petitions for membership have you first line signed? __________________
Have you received the Founders Membership Award? ____________________________
How many Blue Honor Keys have you received? (include stars) ____________________

L. Have you attended a Leadership Conference? ____ If so, where? _________________

Have you completed or enrolled in the Leadership Correspondence Course? __________
What course are you working on currently?______ All five complete?_______________
Have you read the book “Hi Dad”? ___________________________________________

M. I would rate myself in this area as:

 Excellent Above Average Average  Fair  Needs Improvement
TEAM SPORTS
A DeMolay should be interested in physical activities and actively participate in them, not only
to ensure physical fitness but also to develop teamwork and leadership skills.
A. Have you actively participated in at least one sport involving team play, such as
football, softball, soccer, and the like?___ If so, what?____________________________
B. On what teams, organized or unorganized, have you played during the previous two
years (school, church, civic, work-related, etc.)? Year
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

C. What, if any, letters, honors, awards, leadership positions, etc, have you obtained for
any of the above activities? _________________________________________________
________________________________________________________________________
D. Letter from coach, A letter or statement from your coach(s) may be attached to aid in
the evaluation of this form. If your coach(s) feels that your spirit of teamwork has
improved as a result of your membership in DeMolay, his/her letter should state so.

E. Press notices, photographs, of your participation may be attached to aid in the

evaluation of this form, but are not required. Submit copies of any originals.

F. I would rate myself in this area as:

 Excellent Above Average Average  Fair  Needs Improvement

SOCIAL ACTIVITIES
A DeMolay should participate in a variety of social activities that provide wholesome recreation,
in both DeMolay and non-DeMolay settings. Such activities include involvement in local,
national, and international organizations, as well as informal group activities such as clubs,
teams, school clubs, and the like.

A. To what organizations other than DeMolay (i.e. Boy Scouts, Junior Achievement, FFA,
4-H, etc.) do you belong to? _________________________________________________
________________________________________________________________________

B. Of those listed above, which organizations’ meetings do you attend regularly?

________________________________________________________________________

C. What informal social activities do you regularly participate in? ____________________

________________________________________________________________________
________________________________________________________________________

D. I would rate myself in this area as:

 Excellent Above Average Average  Fair  Needs Improvement
INTERNET ACTIVIES
A DeMolay should be a well rounded individual including technological abilities. The internet has
changed the way we process things, communicate, and interact as a society.

A. Do you have a favorite website or sites you visit often? Please list them:
________________________________________________________________________
________________________________________________________________________
B. Do you have a personal website? If so, what is it? _______________________________

C. Do you play online games with friends or other people? Why or Why not?
________________________________________________________________________
________________________________________________________________________

D. Do you prefer to play alone or with friends when it comes to video, computer, or online
games? Why? ____________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

E. How many hours a day would you say you spend on the internet ? (including email,
messaging, gaming, blogging, chatting, etc) ____________________ Is that too much
time? Why or Why not? ____________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

F. I would rate myself in this area as:

 Excellent Above Average Average  Fair  Needs Improvement

FIDELITY
“A DeMolay can never justly be false to his vows, his promises, his friends, his God.”

CAREER/FUTURE GOALS
A DeMolay should give careful attention to his career and future goals as he decides which
activities to participate in throughout his life.

A. What career(s) are you most interested in? ____________________________________

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
 B. What about that career or those careers interest you? ______________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

C. What or who has influenced you the most in determining your future goals?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

D. What are your future goals other than those relating to your chosen career?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

E. I would rate myself in this area as:

 Excellent Above Average Average  Fair  Needs Improvement

MANUAL SKILLS
A DeMolay should have a fair degree of skill with his hands, either in mechanical work,
construction, or the arts.
A. What have you done to demonstrate your ability to repair, assemble, or maintain in proper
working order some piece of machinery? Examples include, but are not limited to: automotive
repair, computer assembly, audio installation, etc.)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

B. What have you done to demonstrate your ability to use tools in a proper manner toward the
completion of some construction project? ____________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
C. What have you done to demonstrate your ability to create works of art?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
D. Photographs or other reproductions of your work may be attached to aid in the evaluation of
this form, but are not required.
E. I would rate myself in this area as:
 Excellent Above Average Average  Fair  Needs Improvement

FINANCIAL RESPONSIBILITY
A DeMolay should have responsible spending habits and develop the necessary skills to handle
his personal financial matters.

A. Do you keep a record of your expenditures? _____________

Do you regularly plan your expenditures? _______________
Do you execute your plan reasonable well? ___________ Why or Why not? _____________
______________________________________________________________________________
______________________________________________________________________________
B. Are you currently employed? _______ If so, where? ________________________________
Do you maintain a checking account? __________ A savings account? _________________
Do you live at home with a parent(s) or guardian? ______ Somewhere else?_____________
Are you much in debt? __________ If so, do you have a plan to get out of debt? __________

C. If you are employed, what percent of your income do you-

Save ____________ Invest __________ Spend for recreation ___________________
Use for self support (clothes, food, school expenses, gas, car ) ________________________
Contribute to the support of your own home? ______________________________________
(total should be 100%)
D. I would rate myself in this area as:
 Excellent Above Average Average  Fair  Needs Improvement

CLEANNESS
“Only in cleanness can a DeMolay rightly be representative of the pureness of our teachings.”

HEALTH EDUCATION
A DeMolay should have adequate knowledge of the rules for good physical health and hygiene
and practice them regularly.
A. Name four (4) things that are beneficial and harmful for your physical and mental health.
Beneficial: Harmful:
1)_______________________________ 1)_______________________________
2)_______________________________ 2)_______________________________
3)_______________________________ 3)_______________________________
4)_______________________________ 4)_______________________________
B. What is your opinion of the use of drugs and alcohol and their effects upon the human body,
mind, and behavior? _____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

C. Habits- Provide information about your habits regarding each of the following:
Sleep – How many hours of sleep do you average each night? _______ Week? _________
Bathing – How often do you bathe? ___________________________________________
Teeth – How do you care for your teeth? ________________________________________

D. What have you learned about venereal diseases and how to prevent their transmission?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

E. I would rate myself in this area as:

 Excellent Above Average Average  Fair  Needs Improvement

PHYSICAL FITNESS
A DeMolay should be in good physical condition and participate in activities to ensure he is
getting the desired amount of exercise.

A. Do you currently have a job that requires physical activity? ___________________________

If “yes” please describe the nature of your job: ________________________________________
______________________________________________________________________________

B. Do you participate regularly in outdoor activities such as running, camping, cycling, hunting,
fishing, swimming, skiing, etc.? __________ If “yes”, please list any you have participated in
during the past year: _____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

C. What individual sports have you participated in competitively during the previous two years
such as golf, track and field, tennis, bowling, etc.? Please list the year of participation.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

D. What, if any, diet and exercise program do you follow?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
E. How would you describe your general physical condition?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

F. What is your - Age? ___________ Weight? _____________ Height? ____________

G. Press notices, photographs, etc of your participation may be attached to aid in the evaluation
of this form, but are not required. Submit copies of any originals you wish to keep.

H. I would rate myself in this area as:

 Excellent Above Average Average  Fair  Needs Improvement

PATRIOTISM
“…each day affords new opportunities to stand as good and upright citizens in behalf of that beloved banner and
our hallowed land.”

EDUCATION
A DeMolay should not only be eager to better himself through education but should also receive
a deeper appreciation of the role that the public school system serves in our country, providing a
foundation upon which useful citizenship will be built in future years.

A. Are you currently attending school? _____ If so, where? __________________________

What is the year of the class (or grade) you are currently? _________________________
What, if any, school do you plan to attend next year? _____________________________

B. What was your grade point average in school - last semester? _______ last year?_______
What honors or awards have you received as a result of your scholastic achievement?
________________________________________________________________________

C. What clubs, groups, or societies have you participated in at school during the past year?
(i.e. student council, Spanish club, honor society, yearbook staff, etc.)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

D. Letter from teacher. A letter or statement from one of your teachers may be attached to aid in
the evaluation of this form. If your teacher feels that your study skills and/or academic
performance have improved as a result of your membership in DeMolay his/her letter should
state so.
E. Report Card. If you were in school during the past year, a copy of your report card MUST
BE ATTACHED to this form for it to be considered complete.

F. I would rate myself in this area as:

 Excellent Above Average Average  Fair  Needs Improvement

CITIZENSHIP
A DeMolay should conduct himself in such a way as to be thought of as a good citizen of this
country and community. This includes following the laws of his city, state, and nation, always
giving dedicated, thoughtful service toward the public good.

A. Have you ever been arrested or ticketed by law enforcement? _____ If “yes”, please list the
date(s) and circumstances for the infraction(s).
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

B. What community project have you participated in to benefit the community? Examples
include adopt-a-highway, planting trees, street cleaning, etc.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

C. What person in your city, state, or nation do you most admire, and what has he or she done for
you to consider him/her a good citizen? ___________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

D. I would rate myself in this area as:

 Excellent Above Average Average  Fair  Needs Improvement

CIVIC DEVELOPMENT
“A public-spirited citizen should be willing to render such public service as in his power”

A. Who is the President of the United States?______________________________________

Who is the Governor of your State/Province?____________________________________
Who is the Mayor of your City or town?________________________________________
B. List the three branches of government and how they work to benefit one another.
_________________________________

 

___________________________  ___________________________
Explanation:__________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

C. Name one State Senator and one State Representative:

__________________________________ ____________________________________

D. What does it mean when someone says they are Democratic or Republican?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

E. Which of the following are not a Constitutional Amendment?

 Right to Bear Arms  Right to a Speedy Trial  Freedom of Religion
 Freedom of Speech  Right to Remain Silent  Separation of Church & State

F. Which Constitutional Amendment means the most to you and why?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
G. What piece of legislation would you put forth to become law if you could and why?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

H. What is the importance of voting for our President, Senators, etc?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

D. I would rate myself in this area as:

 Excellent Above Average Average  Fair  Needs Improvement

SELF EXPRESSION
The First Amendment to the United States Constitution guarantees to every citizen freedom of
speech, and a DeMolay should take opportunities to responsibly exercise that right.

A. What have you done to develop your ability to speak in public?

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

B. In what situations, circumstances, or ceremonies have you spoken publicly during the previous two
years such as student council, oratorical contests, debate, radio broadcasts, etc?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

C. What are some other ways you show self expression? _______________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
 WHAT HAS DEMOLAY DONE FOR YOU?
To answer this question properly, you MUST attach to this form an essay describing what
benefits you have received through your involvement with the Order of DeMolay. This essay
will provide valuable evidence of the importance of the Order of DeMolay because of its
influence upon the lives of young men. To answer this question, your essay should show, in
some detail, the influence that the Order has had on your life, including your ideals of moral
conduct, assuming responsibility, and improvements in your home life. Your essay may be
written in the form of a story or a theme, but remember that the longer your essay is, the more
detail will be available for consideration by the evaluator of this form.

I, ______________________________________, hereby certify on my honor as a DeMolay,

that the facts given in this form and accompanying documents presented by me are true and
accurate and that all statements given by others attached to this record are, to the best of my
knowledge true and accurate. If granted this distinction, I furthermore pledge on my honor as a
DeMolay that I will continue to the best of my ability put the ideals of DeMolay into practice in
my daily life; each year hereafter I will endeavor to help at least one DeMolay to qualify as a
Representative DeMolay and should I feel I have proven myself unworthy of this honor, I will,
of my own initiative, voluntarily return the insignia of this distinction to the Advisory Council
and/or Executive Officer of the jurisdiction in which I reside or to the Grand Secretary at
DeMolay International Service & Leadership Center.

Signed:__________________________________________________________________ Date_____________

Advisory Council
The Advisor Council approves and submits this record on behalf of this Chapter for
consideration and commends the above named DeMolay as one who would, in all respects,
reflect credit upon the Order as a Representative DeMolay if his qualifications, as set forth,
should be deemed sufficient to merit that distinction. This applicant has filled out this form to the
best of his ability to show that he is a well rounded individual and should be considered
representative of DeMolay in this Chapter.

Signed:______________________________________ Signed:_________________________________
Chairman of the Advisory Council / R.D. Advisor Chapter Advisor

Print Name:____________________________ Print Name:_______________________

Address:_______________________________ Address:_________________________
City_______________ State____ Zip _______ City____________ State____ Zip_____
Phone (_____) _________________________ Phone (____) _____________________
Email_________________________________ Email ___________________________