Scholarship Application

Scholarship Application: Girl Event - Camp - Travel
Program Scholarships (Events, Camps, Travel)

Girl Scouts Dakota Horizons (GSDH) is committed to providing all girls the opportunity to participate in the Girl Scout Leadership Experience. This scholarship is designed to assist new and renewing girl members in our council jurisdiction by providing supplemental resources beyond a family’s ability to pay.

Important Information
- Submit scholarship request at least 1 week prior to program registration deadline.
- GSUSA Destinations Trip Scholarship information and submission form(s) can be found on our website. Scholarships & Aid - GSUSA Destinations Scholarship Application
- Service Unit/Troop Programs: Scholarships for service unit programs are managed by the service unit. Inquire directly with your troop leader and/or service unit manager regarding requests for programs planned and facilitated by your local service unit and troops.
- Dakota Horizons Council Programs: This form serves as both an application for scholarship, and if approved, becomes the Girl Scout's registration form for the program.
- Scholarships will not be provided for funds already spent.
- Scholarships requested by troop co-leaders for multiple troop members will be reviewed and are granted on a case by case basis.
- If your Girl Scout is not able to attend, please contact us at help@gsdakotahorizons.org to submit a cancellation. Cancellations made within 3 weeks of the session date or no-show instances may affect future scholarship opportunities for the Girl Scout.
- Scholarship allocations are subject to available funds within the council’s current operating budget.
Scholarship Requested By:*

Girl Scout Parent/GuardianTroop Co-Leader

Parent/Guardian Name*

First NameLast Name
Troop Co-Leader Name*

First NameLast Name
Troop Number
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Event/Camp/Travel Information
Event/Camp/Travel Name*
Event/Camp/Travel Date*
Event/Camp/Travel Location (city, state)*
Individual Girl Program Price*
Enter the full individual girl price for the program

Scholarship Amount Requested

Girl Scouts Dakota Horizons encourages girls to become self-sufficient through participation in the product programs. Additionally, she and her caregivers can seek support from the troop and the local Girl Scout body known as the service unit. Inquire with your troop co-leader and/or service unit manager to get the conversation started.
Individual Girl Program Price*
Family Contribution *
Enter contributing amount if applicable. (Dakota Dough/Check/Credit Card))
Troop Contribution*
Enter contributing amount if applicable
Service Unit Contribution*
Enter contributing amount if applicable
Scholarship Amount Requested (program price less contributing payments)
Contributing Payments Due (on or before registration deadline)
Program Price Contributing Payments

Submit contributing payments with a copy of the scholarship request or paper registration form to:

Girl Scouts Dakota Horizons
1002 43rd St S
Fargo, ND 58103
Attn: Program Registration

All payments are due on or before the program registration deadline.

Girl Participant Information
Girl Name*

First NameLast Name
Grade*
Select the grade level corresponding to the Girl Scout Year, Oct 1- Sept 30, within which the request is made.
Girl Scout Level*
Special Needs – please list any special needs (dietary, activity restrictions, etc.) you would like to make event planners aware of before the program.
T-shirt Size*
*T-shirts not included for all programs. See the specific program listing at gsdakotahorizons.org for details.
How does she participate in Girl Scouts?*

Individually Registered Girl (IRG/Juliette)TroopUnsure
Does girl qualify for:*

Reduced MealsFree MealsNeither
5 Digit Troop Number
Adult Emergency Contact During Event/Camp/Travel
Emergency Contact Name*

First NameLast Name
Phone Number *

Area CodePhone Number

Troop Co-Leader Scholarship Request
1. Girl Name*

First NameLast Name
Troop *
Grade*
Select the grade level corresponding to the Girl Scout Year, Oct 1- Sept 30, within which the request is made.
Girl Scout Level*
1. T-shirt Size*
*T-shirts not included for all programs. See the specific program listing at gsdakotahorizons.org for details.
Does girl qualify for:*

Reduced MealsFree MealsNeither
1. Parent/Guardian Email*
example@example.com
1. Girl Emergency Contact Name*

First NameLast Name
1. Girl Emergency Contact Phone*

Area CodePhone Number
Do you have more girl troop members to submit? (Up to 8 girls can be submitted per form. Complete additional form entries as needed.)*

YESNO

2. Girl Name

First NameLast Name
Troop
Grade
Select the grade level corresponding to the Girl Scout Year, Oct 1- Sept 30, within which the request is made.
Girl Scout Level
2. T-shirt Size
*T-shirts not included for all programs. See the specific program listing at gsdakotahorizons.org for details.
Does girl qualify for:

Reduced MealsFree MealsNeither
2. Parent/Guardian Email
example@example.com
2. Girl Emergency Contact Name

First NameLast Name
2. Girl Emergency Contact Phone

Area CodePhone Number
Do you have more girl troop members to submit? (Up to 8 girls can be submitted per form. Complete additional form entries as needed.)

YESNO

3. Girl Name

First NameLast Name
Troop
Girl Scout Level
Grade
Select the grade level corresponding to the Girl Scout Year, Oct 1- Sept 30, within which the request is made.
Does girl qualify for:

Reduced MealsFree MealsNeither
3. T-shirt Size
*T-shirts not included for all programs. See the specific program listing at gsdakotahorizons.org for details.
3. Parent/Guardian Email
example@example.com
3. Girl Emergency Contact Name

First NameLast Name
3. Girl Emergency Contact Phone

Area CodePhone Number
Do you have more girl troop members to submit? (Up to 8 girls can be submitted per entry. Complete additional form entries as needed.)

YESNO

4. Girl Name

First NameLast Name
Troop
Girl Scout Level
Grade
Select the grade level corresponding to the Girl Scout Year, Oct 1- Sept 30, within which the request is made.
Does girl qualify for:

Reduced MealsFree MealsNeither
4. T-shirt Size
*T-shirts not included for all programs. See the specific program listing at gsdakotahorizons.org for details.
4. Parent/Guardian Email
example@example.com
4. Girl Emergency Contact Name

First NameLast Name
4. Girl Emergency Contact Phone

Area CodePhone Number
Do you have more girl troop members to submit? (Up to 8 girls can be submitted per entry. Complete additional form entries as needed.)

YESNO

5. Girl Name

First NameLast Name
Troop
Girl Scout Level
Grade
Select the grade level corresponding to the Girl Scout Year, Oct 1- Sept 30, within which the request is made.
Does girl qualify for:

Reduced MealsFree MealsNeither
5. T-shirt Size
*T-shirts not included for all programs. See the specific program listing at gsdakotahorizons.org for details.
5. Parent/Guardian Email
example@example.com
5. Girl Emergency Contact Name

First NameLast Name
5. Girl Emergency Contact Phone

Area CodePhone Number
Do you have more girl troop members to submit? (Up to 8 girls can be submitted per entry. Complete additional form entries as needed.)

YESNO

6. Girl Name

First NameLast Name
Troop
Girl Scout Level
Grade
Select the grade level corresponding to the Girl Scout Year, Oct 1- Sept 30, within which the request is made.
Does girl qualify for:

Reduced MealsFree MealsNeither
6. T-shirt Size
*T-shirts not included for all programs. See the specific program listing at gsdakotahorizons.org for details.
6. Parent/Guardian Email
example@example.com
6. Girl Emergency Contact Name

First NameLast Name
6. Girl Emergency Contact Phone

Area CodePhone Number
Do you have more girl troop members to submit? (Up to 8 girls can be submitted per entry. Complete additional form entries as needed.)

YESNO

7. Girl Name

First NameLast Name
Troop
Girl Scout Level
Grade
Select the grade level corresponding to the Girl Scout Year, Oct 1- Sept 30, within which the request is made.
Does girl qualify for:

Reduced MealsFree MealsNeither
7. T-shirt Size
*T-shirts not included for all programs. See the specific program listing at gsdakotahorizons.org for details.
7. Parent/Guardian Email
example@example.com
7. Girl Emergency Contact Name

First NameLast Name
7. Girl Emergency Contact Phone

Area CodePhone Number
Do you have more girl troop members to submit? (Up to 8 girls can be submitted per entry. Complete additional form entries as needed.)

YESNO

8. Girl Name

First NameLast Name
Troop
Girl Scout Level
Grade
Select the grade level corresponding to the Girl Scout Year, Oct 1- Sept 30, within which the request is made.
Does girl qualify for:

Reduced MealsFree MealsNeither
8. T-shirt Size
*T-shirts not included for all programs. See the specific program listing at gsdakotahorizons.org for details.
8. Parent/Guardian Email
example@example.com
8. Girl Emergency Contact Name

First NameLast Name
8. Girl Emergency Contact Phone

Area CodePhone Number

1. Girl Name

First NameLast Name
Scholarship Amount Requested $*
Enter dollar amount for this Girl Scout's request
2. Girl Name

First NameLast Name
Scholarship Amount Requested $
Enter dollar amount for this Girl Scout's request
3. Girl Name

First NameLast Name
Scholarship Amount Requested $
Enter dollar amount for this Girl Scout's request
4. Girl Name

First NameLast Name
Scholarship Amount Requested $
Enter dollar amount for this Girl Scout's request
5. Girl Name

First NameLast Name
Scholarship Amount Requested $
Enter dollar amount for this Girl Scout's request
6. Girl Name

First NameLast Name
Scholarship Amount Requested $
Enter dollar amount for this Girl Scout's request
7. Girl Name

First NameLast Name
Scholarship Amount Requested $
Enter dollar amount for this Girl Scout's request
8. Girl Name

First NameLast Name
Scholarship Amount Requested $
Enter dollar amount for this Girl Scout's request
Total Scholarship Amount Requested $
Special Needs – please list any special needs (dietary, activity restrictions, etc.) you would like to make event planners aware of before the program. List girl name and need.
Program Price Contributing Payments

Submit troop, service unit or family contributing payments with a copy of the scholarship request(s) or an event registration form to:
Girl Scouts Dakota Horizons, 1002 43rd St S, Fargo, ND 58103, Attn: Program Registration
Alternatively, a contributing payment may also be submitted with a paper event registration form.
All payments are due on or before the program registration deadline.

Additional information - feel free to add comments pertaining to the request.
An email including a copy of the scholarship form will be sent to the email address of the person submitting the form.

Upon review of your application, you will receive an email notifying you of an approval or decline. Please allow 7-10 days for notification.

Click submit below to complete your submission.

Questions, contact us at help@gsdakotahorizons.org, 800-666-2141
Should be Empty:

Scholarship Application: Girl Event - Camp - Travel

Event/Camp/Travel Information

Scholarship Amount Requested

Girl Participant Information

Adult Emergency Contact During Event/Camp/Travel

Troop Co-Leader Scholarship Request