Membership Dues Financial Assistance Application

Membership Dues Financial Assistance Application

Use this form when requesting assistance for membership dues.
GSLPG is committed to helping all girls participate in Girl Scouting regardless of their family's income. To encourage participation and give new girls the opportunity to get the Girl Scout Experience, GSLPG will provide membership dues financial assistance to new girl members when available.

Membership Dues Financial Aid eligibility is geared towards first time members who have not yet had the opportunity for money earning activities, however, we recognize that extenuating circumstances exist and there will be a section on the form to complete for these circumstances.

Qualifying for assistance is based on several factors including available grant funding, membership status, as well as extenuating circumstances.

Financial assistance is limited and the application must be submitted by the girl's legal parent/guardian. Questions and concerns may be directed to the customer service department at info@gslpg.org.
Girl Scout's Name*

First NameLast Name
Name of Parent or Guardian submitting application*

First NameLast Name
Parent or Guardian contact phone number*

Area CodePhone Number
Email address of parent or guardian*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parish*
Please tell us what parish you currently live in
Girls' membership status?*

I am new member of Girl ScoutsI am a returning member of Girl Scouts with a lapsed membership (You were a member in the 2022 membership year, were NOT a member in the current 2023 membership year, and are returning for the 2024 membership year)I am a current member of Girl Scouts
Troop Number or IRG*
If you are an individually registered girl, please type IRG in the blank.
Did you or your troop participate in any money earning activities (fall product, cookie program or other approved fundraisers) for the 2022-2023 Membership Year?*

YesNo
Please list all money earning activities for the 2022-2023 Girl Scout Membership Year.*
Extenuating Circumstances

Membership Dues Financial Aid eligibility is geared towards first time members who have not yet had the opportunity for money earning activities, however, we recognize that extenuating circumstances exist.

If your family falls into any of the categories below, please let us know. If other, please explain so that we may determine your eligibility.
Extenuating Circumstances*

HomeslessnessRecent change in family structureRecent job lossSignificant illnessNatural disaster (flood, fire, hurricane, etc.)None of the aboveOther, please explain
If you selected Natural Disaster, please explain the type of disaster as well as when and where it occurred so that we may evaluate your application to determine eligibility.*
If you selected other, please explain any extenuating circumstances so that we may evaluate your application to determine eligibility.*
Agreement and Acknowledgement

By applying and e-signing this form for financial assistance, I am indicating that I am the parent/guardian of the Girl Scout applicant and all of the information provided is correct to the best of my knowledge.

I accept and agree to abide by the Girl Scout Promise and the Girl Scout Law.
Signature of Parent/Guardian*

Clear
Should be Empty: