Request for Financial Assistance

Request for Financial Assistance - Program Events
Girl Scouts of Western Ohio provides financial assistance to individual applicants based on specific financial need, and the applicant's compliance with the financial assistance philosophy of the Girl Scouts.

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 parent/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 *
Section II. Event/Resource Information
Name of Event/Activity/Handbook *
Event Dates *

Month Day Year
Date
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 without financial assistance? *

Yes No
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.
Parent/Caregiver Signature *

Clear
Today's Date *

Month Day Year
Date
Should be Empty:

Request for Financial Assistance - Program Events

Section I. Applicant Information

Section II. Event/Resource Information