Adult CPR/First Aid FA Request
Please use this form to request Financial Assistance after completing a Girl Scout approved Adult CPR/First Aid course.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position
*
Ex. Troop Leader, Co-Leader, Service Unit Manager, etc.
CPR/First Aid Training Status
*
Not certified, but I am registered for a class.
Already certified, I have attached my CPR/First Aid card.
If currently registered for a CPR/First Aid course, please provide the details below.
Date, time, location, & any other information that would be helpful like instructor and certifying organization (Red Cross, American Heart Association, etc.)
Financial Assistance is limited, in order to be considered you must be a current and approved GSLPG adult volunteer. You must get certified by a GSUSA recognized certifying organization, a list can be found in the Safety Activity Checkpoints at gslpg.org. In order to be approved the CPR/First Aid course must include in person, hands on training. Online only certifications do not meet the GSUSA requirements for acceptable certification. All certification cards must be submitted either through this form or emailed to info@gslpg.org to be eligible for financial assistance.
*
I understand and agree.
Please upload a current proof of CPR/First Aid certification from a Girl Scout approved certifying body here. Alternatively, you may also email it to info@gslpg.org for review.
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