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, GSLPG will provide financial assistance to girl members only for membership, program events, and summer camp.

Qualifying for assistance is based on your family's household size and reported income.

Financial assistance 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*

First NameLast Name
Parent or Guardian contact phone number*

Area CodePhone Number
Email address of parent or guardian*
example@example.com
Girls' membership status?*

I am new member of Girl ScoutsI am a current member of Girl ScoutsI am a returning member of Girl Scouts with a lapsed membership
Troop Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of dependents as listed on your latest income tax return*
Total family income, before deductions?
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: