GSKH Girl Membership Financial Aid Application

GIRL SCOUTS OF KANSAS HEARTLAND: Girl Membership Financial Aid

MEMBERSHIP FINANCIAL AID APPLICATION AND GUIDELINES: The Girl Scouts of Kansas Heartland (GSKH) Financial Aid program offers girls and adults the opportunity to participate in Girl Scouting. Financial Aid for the annual Girl Scout membership fee may be requested while completing the online membership registration process. An application is required. Financial Aid is granted based on financial need and the availability of funds. Financial Aid is not designed to replace Program Credits earned by Girl Scouts. This form must be completed by the PARENT/GUARDIAN. Financial Aid must be selected at the time of registration. A refund will not be given if membership is paid in advance and then Financial Aid is requested. Incomplete registrations will be returned to the parent/guardian and will need to be resubmitted for consideration.
Girl Name:*

First NameLast Name
Girl Date of Birth: *

MonthDayYear
Name of Parent or Guardian:*

First NameLast Name
Phone Number:*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:*
County of Residence: *
Occupation of Parent(s) or Guardian(s):*
Annual Household Income Level:*
Number of Dependents in Household:*
Number of Adults in Household:*
Number of girls in Girl Scouts:*
Are there extenuating circumstanes that affect your income?
Girl Scouts of Kansas Heartland is partnered with the KanCare program. If you're currently a recipient of one of the KanCare providers (Healthy Blue, Sunflower Health Plan, United Healthcare), you may be eligible to utilize your KanCare dollars to purchase uniforms.
- You can utilize $50 per calendar year for Sunflower Health Plan and United Healthcare, or up to $75 for Healthy Blue.
- This form must be completed in its entirety.
- For Sunflower and United Health Care, the council will submit to your insurance provider on your behalf. For Healthy Blue, you will need to request a gift card for your funds - more information here: https://www.healthybluekansas.com/medicaid/extras
- Your Council Cares application approval is not contingent on KanCare funding.
Is the Girl Scout requesting the Financial Aid a KanCare recipient?**

YesNo
9-digit KanCare ID#: *
KanCare Provider:*

Healthy BlueSunflower Health PlanUnited Healthcare
Parent/Guardian Signature*

First NameLast Name
Date*

MonthDayYear
Date
Financial Aid awards help girls enjoy the benefits of Girl Scouting. The Council appreciates and welcomes donations designated for the GSKH Financial Aid Fund.
Should be Empty:

GIRL SCOUTS OF KANSAS HEARTLAND: Girl Membership Financial Aid

Financial Aid awards help girls enjoy the benefits of Girl Scouting. The Council appreciates and welcomes donations designated for the GSKH Financial Aid Fund.