Interpreter Strip Confirmation

Dear Instructor,
The Boy Scout that gave you this form would like to be tested for his ability to interpret a language in his pursuit of an Interpreter Strip recognition.   Please determine if the Scout passes the following requirements.   If so, please fill out your contact information, sign, and return to the Scout.
              Thank you,
              ____________________________ Scoutmaster Troop ______

Language: ______________

  1. _____ Carry on a five minute conversation in this language.
  2. _____ Translate a two-minute speech or address.
  3. _____ Write a letter in the language.
  4. _____ Translate 200 words from this language to English or back.

Scout's Name:_____________________________________
School Name:_____________________________________
Instructor Name:_____________________________________

I attest that this Boy Scout has passed the above requirements.