Uniform Financial Assistance

Uniform Financial Assistance Application

Your request will be processed within 10 business days.
Girl Information
Girl's Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Regional Area*
Troop Number*
LEAD
Date of Birth*

MonthDayYear
Participant is a*

New Girl ScoutReturning Member of Girl Scouts
How many years has your girl been in Girl Scouts?
Daisy uniforms include small tunic. Brownie–Ambassador uniforms include extra long sash. All levels include flag, troop numbers, council ID, insignia tab, and WAGGGS pin.
Which level is your Girl Scout?*

Daisy (Kindergarten-1 Grade)Brownie (2-3 Grade)Junior (4 -5 Grade)Cadette (6-8 Grade)Senior (9-10 Grade)Ambassador (11 -12 Grade)
Do you want a tunic/sash or vest?*

Tunic/SashVest
If requesting a vest instead of a sash, you will need to pay the difference of $16.50. The Nashville Cabin will contact you to take your card number over the phone before your order is fufilled.
Family Information
Guardian Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Secondary Phone Number if Available
Please enter a valid phone number.
Email*
example@example.com
Number of Children Living at Home
under the age of 18
Number of Dependents on Family Income
Ages
Total Annual Income

$0 - $12,000$12,001 - $15,000$15,001 - $18,000$18,001 - $21,000$21,001 - $25,000$25,001 - $30,000$30,001 - $40,000$40,001 - $50,000$50,001 - $60,000over $60,000$0 - $12,000
How much can you contribute to the uniform fee?
Income sources (check all that apply)

SalariesDisabilityUnemploymentSocial SecurityChild SupportOther
Employer
Circumstances for Your Request
Please describe the circumstances that explain your assistance need*

0/200
Have you ever received financial assistance from Girl Scouts of Middle Tennessee?*

YesNo
Guardian Signature*

Clear
Date

MonthDayYear
Date
Should be Empty:

Uniform Financial Assistance Application

Girl Information

Family Information

Circumstances for Your Request