Juliette Fund Application

Juliette Fund Application
The Juliette Fund is accessible to Girl Scouts who have contributed by participating in Cookie and Fall Product Programs as Independently Registered Members. The fund can be used exclusively for purchasing uniforms, badges, program materials, and for covering membership dues or event registration fees.

Each request is individually reviewed by a Product Program Staff Member, taking into account the type of event and the scout’s participation in Product Programs.
Reason for Request*

Council Program/EventCouncil Summer CampCouncil Boutique PurchaseAnnual Membership DuesOther
Details of Boutique Purchase*
Which Summer Camp should we apply the payment to? *
Summer Camp Name
Who should the membership payment be applied to?*
Summer Camp Name
Which Council Event should we apply the payment to? *
Council Event Name
Date Needed By:*

MonthDayYear
Date
Girl Scout Program Age Level*
What Product Programs have you participated in? (check all that apply)*

Cookie Product ProgramFall Nut and Magazine Product Program
Service Unit #
Name of Girl Scout applying for funds*

First NameLast Name
Name of Parent/Guardian*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Daytime Phone Number*

Area CodePhone Number
Signature of Parent/Guardian*

Clear
Should be Empty: