Reporting Card

Membership Numeral Guards are for registered adult members, including lifetime members. This pin represents your total number of years as a Girl Scout member including years spent as a Girl and as an Adult.

Years of Service Pins are for registered adult Volunteers, meaning adult members who are an active volunteer in any capacity. For Years of Service, years spent as a Girl do not count and years as a lifetime member but not in a volunteer role do not count.

This form is for you to self-report your membership years and years of service so we can accurately honor your membership and service.

Once completed this form will be sent to your membership specialist for updating our systems. You will recieve a copy of this form in your email inbox and your Service Unit Adult Awards Coordinator or Service Unit Manager that you enter in the field below will also get a copy for their records.

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Service Unit*

SU Manager or Adult Awards Coordinator Email Address*

example@example.com

The Girl Scout year runs October 1st through September 30th.

When self-reporting your years of membershp and service, do not include the current membership year in your count. Please list only the full completed years. For example,

If you were not a Girl Scout as a child and you've been a volunteer since Fall 2018 then you have spent the following Girl Scout years as a volunteer.
2018-2019, 2019-2020, 2020-2021, 2021-2022, 2022-2023. We're not going to include the current year, 2023-204 so your years of service would be 5 and this year is your 6th.

Our system will automatically add a year to your profile on October 1st, so in order for your years to be accurate, do not include the current year on the number you submit on this form.

How many years were you a child Girl Scout Member? *

How many years were you an Adult Member? *

How many years have you been an active volunteer? *

Total Membership Years

What Membership Numeral Guard do you need? In increments of 5 from 5 Yr+. If you don't need one at this time, write "none". *

What Year of Service Pin do you need? In increments of 5 from 5Yr.+. If you don't need one at this time, write "none". *

Please add anything here you would like the membership staff or your service unit leaders to know.