Community Recognitions Request Form My21

Community Recognitions Request Form

Girl Scouts of Kansas Heartland will provide an official letter of recognition and/or certificate of appreciation to community members, businesses, or organizations that support or provide assistance to a troop, group, or Council. Examples include guest speakers, program partners, and organizations that provide meeting spaces to troops. Form open from July 11 - August 11.

Date

Name

First Name Last Name

Email

example@example.com

Which best describes your role (check all that apply):

Girl Member Caregiver of Girl Member Troop Leader Troop Support or other Troop Volunteer Service Unit Volunteer Council Volunteer (Board, Awards Committee, Volunteer Advisory, Training Facilitator, etc.) Council Staff

Troop Number, if applicable

Service Unit Number, if applicable

How would you like the letter and/or certificate delivered? *

Mail directly to the recipient. Provide to me for personal presentation to the recipient.

Who are you recognizing?

Individual Community Member Business or Organization

Name - Individual Community Member

First Name Last Name

Business or Organization Name

Name - Point of Contact for Business or Organization

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

What is the frequency or duration of the support provided?

One specific occasion Multiple specific occasions Ongoing, less than 1 year Ongoing, 1-3 years Ongoing, more than 3 years

Brief description of the recipient's service or support provided to Girl Scouts. *