Participation Form
Holocaust Education Patch
Your name
*
First Name
Last Name
Your email
*
example@example.com
Your phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What is your role?
*
Troop Leader
Girl Scout
Parent of a Girl Scout
A teacher looking to have their students earn the patch
An individual looking to earn the patch (unaffiliated with Girl Scouts)
An individual looking to have another group earn the patch
Other
Where are you located? (City, State/Country)
*
Please provide a description of your group, number of individuals, and age group.
*
Name of school
*
Number of students to participate
*
Grade Level
*
Your troop's ZIP code
*
How many Scouts are in the troop?
*
What are the ages of the Scouts in your troop?
*
Roughly, when do you plan on completing the patch program curriculum?
*
How did you hear about the Patch Program?
*
Do you have any questions about the patch program?
Submit
Should be Empty: