Request for Financial Assistance

Request for Financial Assistance

Individual girl requests for program events or uniforms
Girl Scouts of Western Ohio provides financial assistance to individual applicants based on specific financial needs, and the applicant's compliance with the financial assistance philosophy of the Girl Scouts.

Financial assistance can be provided for Girl Scout uniforms, grade-level handbooks, and/or events.

Please review the Financial Assistance Application Policies and Procedures prior to filling out the form below.
Section I. Applicant Information

To be completed by the caregiver.
Girl's Name *

First Name Last Name
Troop/Group # *
Parent/Caregiver's Name *

First Name Last Name
Phone Number *
Please enter a valid phone number.
Caregiver's Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Current Grade *
Age *
School District *
County *
Is the applicant a registered member of Girl Scouts? *

Yes No
Financial Assistance Request
I am requesting financial assistance for: *

Uniform / Grade-level handbook Event
Financial Assistance: Uniform
Has your troop collectively decided to wear uniforms?

Yes No
My troop plans to/has participated in this year's Girl Scout Cookie Program.

I agree
Will your troop participate in either the Fall Product or Girl Scout Cookie Program?

Yes No
I understand that we must contribute at least $5 in order to be eligible for uniform assistance (note: payment is expected at the time of purchase).

I understand
I understand that we must contribute at least $5 in order to be eligible for uniform assistance (note: payment is expected at the time of purchase).

Yes No

Financial Assistance: Program or Event
Name of program or event
Event Date

Month Day Year
Date
Event Location
How did your daughter assist in the planning and preparation for this activity?

With her troop/group With another group (explain) Individually (explain)
Explain
Has your daughter's participation in this activity been confirmed?

Yes No
Parent/Caregiver answer: I want my daughter to participate in this activity because...
Girl Scout answer: I want to participate in this activity because...
Does this applicant have a specific and distinct financial need?

Yes No
Would the applicant be able to participate in the event/activity and/or purchase a uniform without financial assistance?

Yes No
Cost of program or event
Amount caregiver can pay
Amount of financial assistance requested
Calculated based on previous responses
(previous) Amount of financial assistance requested:
Please verify that you have reviewed and understand GSWO's Financial Assistance Application Policies and Procedures.

I have reviewed the policies and procedures document.
Please verify that you have reviewed and understand GSWO's Financial Assistance Application Policies and Procedures. *

I have reviewed the policies and procedures.
Parent/Caregiver Signature *

Clear
Today's Date *

Month Day Year
Date
Should be Empty:

	Items requested? (yes/no)
Sash/tunic (tunics are for Daisies only)
American Flag
Council ID Set
Troop Numbers
Insignia Tab
World Trefoil Pin
Grade-level Handbook

Section I. Applicant Information

Financial Assistance Request

Financial Assistance: Uniform

Financial Assistance: Program or Event