#330 Girl Scholarship Request

Girl Scholarship Request
This information is confidential and reviewed only by council staff. Only a parent or caregiver is permitted to complete and sign this form. Please note that the fulfillment process may take approximately 2–3 weeks. Please reach out with questions or concerns to customercare@gseok.org or 918-749-2551.
Girl Scout's Full Name
Troop Number
Years a Girl Scout
Parent/Guardian Name
Parent Email
example@example.com
Address

Address

Street Address Line 2

CityState / Province

Zip
Cell Phone
Girl Scout Level:

Total Annual Family Income (from all sources):
Number of dependent children living at home:
Number of people supported by this income:
List any unusual or extraordinary family expenses or circumstances (unexpected medical expenses, job loss, etc :

Girl Scout participates in GS activities/meetings:
Participated in most recent Girl Scout Cookie Program? (Non-participation significantly impacts amount of financial assistance granted)
If no, why?
Financial Assistance is needed for (Please specify):
Council Activity, Event, or Camp
GSUSA or Council Travel Opportunity

A maximum of 1/2 the total cost of transportation and event fees up to a maximum of $500.00 per trip may be awarded to any girl for up to two travel opportunities - no more than one during a membership year (October-September Applicant is responsible for payment of deposits. Amount of assistance will be determined based on a calculation of need. When applying for assistance for a GSUSA Travel Opportunity, attach a copy of the selection notification letter that lists the dates of the event and the event fee. If for any reason you do not attend this event, all financial assistance and Cookie Credit must be returned to Girl Scouts of Eastern Oklahoma.
GSUSA or Council Travel Opportunity
Cost
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please upload copy of notification letter that lists dates and fees.

Cancelof

Amount you can pay:
Have you received financial assistance from Girl Scouts of Eastern Oklahoma in the past 12 months
Amount received and for what purpose:
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Signature