Program Assistance Grant Application

Grants are given for individual girl or troop participation in Girl Scouts of Central Indiana and Girl Scouts of the USA endorsed events such as GSUSA national and international Destinations, resident and day camp, or council programs. Grants are only given to registered Girl Scouts. Adults are not eligible to apply.

Each girl may apply for one troop, one camp and one individual grant per year.

Cadette, Senior, Ambassadors- may use grant to assist in council program, council camp, council facility overnight, and Girl Scout Destinations.

Juniors- may use grant to assist in council program, council camp, and council facility overnight.

Brownie- may use grant to assist in council program, council camp, council facility overnight

Daisy- may use grant to assist in council program

Financing is meant to assist with extreme need and or unforeseen circumstances beyond the control of the applicant.

To qualify your troop MUST fully participate in the Girl Scout Cookie Sale Program and Fall Product Program (unlesstroop started after sale).

Troops must be in good standing.

Grants can only be submitted 3 months prior to the event. Grants submitted before the 3 months will not be reviewed.

All applicants will be notified by Email as to the disposition of the requests.

The grant committee will look at the following factors when evaluating a grant request.

The application request is based on a realistic goal and includes a sound financial plan.

The financial resources of the applicant, including any special circumstances.

The degree to which the applicant has used her own resources to help pay for the cost of the opportunity.

Type of PAG requested:

Troop Number

Leader's Name

First NameLast Name

Leader Email

example@example.com

Leader Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Troop Program Level(s)

Girls are: (Check all that apply)

I have reviewed the Safety Activity Check Points section appropriate to this activity and assure that all requirements will be met.

Girl's Name

First NameLast Name

Troop Number (If not in a troop, please type "IRG")

Service Unit

Phone Number

Area CodePhone Number

Email

Individual Girl Scout is:

Number of years in Girl Scouting

Birthdate

Date

School Attending

Does girl receive free/reduced lunch at school

Caregiver Signature

Name of Council Program:

Date(s) of program

Detailed description of event (

Have reservations been made?

Has troop/girl received a grant for a Girl Scout activity in the past year?

Did the troop/girl participate in the Fall Product Sale Program?

If no, why not?

Did troop/girl participate in the Girl Scout Cookie Sale Program?

If no, why not?

Email

Transportation

What are your sleeping arrangements

Do you have additional insurance other than Girl Scouts?

A complete itinerary must be submitted that includes dates, times, places and accommodations with a full list of girls and adults. Please upload file before submitting.

Transportation

Camp Fee

Program Fee

Other

Total

Troop

Parent/Guardian

Girl's earnings

Other

Total amount requested

Total annual income:

Number of people supported by this income?

Troop financial balance:(Please check the appropriate amount below.)

Upload most recent troop bank statement.

What is your trip goal?

Are there any special circumstances? (This question must be answered in order for your application to be considered.)

Is the parent/guardian a troop leader?

Does your child receive free or reduced lunch? (This question must be answered in order for your application to be considered.)

What is your child's school district? (This question must be answered in order for your application to be considered.)

Program Assistance Grant Application

Section I: Troop PAG

Troop PAG Applicants please go to section IV to continue

Section II: Individual PAG

If requesting assistance for a council program:

Section IV: Event details and participation

Section V: Budget

Total anticipated cost

Total amount girl/troop can pay