Temp Girl Grant Application for Membership

Girl Grant Application for Membership
Applications are accepted as long as funds are available. Decisions are based on stated financial need.

Any/all Cookie Dough, Program Vouchers, or store gift cards that a girl has earned will be applied prior to Girl Grant funds being used.

Incomplete applications will delay decisions.
Girl Information
Name of Girl*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Girl's Grade ( list grade entering in Fall)*
County where Girl Resides in*
School Attending*
Troop Number
Service Unit Number
Girl Scout Level*

Age of Each Household Member*
(example: 41, 40, 14, 5)
Please describe the circumstances or financial situation that explain why you are applying for a Girl Grant.*

Membership or Uniform Information
Please indicate what you are seeking a Girl Grant for*

GSUSA Anual Membership FeeUniform Tunic or SashAge Level PinCouncil ID SetTroop Numerals
If applying for a uniform, what Service Center will you pick it up at?
By submitting this Girl Grant Application, I attest that the information provided is truthful to the best of my knowledge.

If the application is for a program, I have uploaded proof of my household income or will be mailing it to the Albany Service Center. I understand that no decision will be made until that proof is received by GSNENY.
Digital Signature*
Should be Empty: