Girl Scout Membership & Uniform Assistance Application

Girl Scouts of Central Illinois (GSCI) is committed to ensuring that all youth have the opportunity to participate in Girl Scouting. To help remove financial barriers, GSCI offers financial assistance to individuals who would otherwise be unable to participate without support from the council.

Troops are encouraged to engage girls in girl-led financial planning to support their activities. Financial assistance is intended to supplement (not replace) these efforts and should not be considered a primary funding source for members or troops.

Financial assistance is made possible through grant funding, as well as proceeds from the Girl Scout Fall Product Program and Cookie Program. Membership Financial Assistance provides coverage for one membership year (October 1 – September 30).

Eligibility Guidelines
Please review the following before completing the application:

Eligibility Guidelines Applicant is registering or is already a registered member of GSCI.
Applicant demonstrates financial need and would be unable to participate without assistance.
Youth applicant is encouraged to participate in the council’s product programs (Fall Product and Cookie Program) to support their Girl Scout experience.
Each Girl Scout is eligible to receive assistance for one uniform per program level.
Households must not have any outstanding debt with GSCI.
For adult applicants, you must be able to pass a background check (18 years and older).
Adults will be provided with training once they have passed the background check and placed in an adult volunteer role.

Eligible Expenses
Financial assistance may be applied toward:

Annual membership fees
Up to $20 toward basic uniform components, including:
Sash, Tunic, or Vest
Troop Numerals
GSUSA Council ID Set
American Flag Patch
Membership Pin

Application Process

A separate application must be submitted for each individual member.
Applications must be completed and signed (electronically or physically) by a parent/guardian.
Applicants will be notified of approval via email, including the amount awarded.

Receiving Financial Assistance

After receiving the application approval email, uniform items will be available to be picked up inyour local Trefoil Boutique.
Uniforms purchased before receiving uniform financial assistance approval cannot be refunded.

Income Qualification Guidelines

GSCI follows the same eligibility criteria as the Federal Free and Reduced-Price School Lunch Program. Families who qualify for this program are eligible for financial assistance through GSCI.

Who are you asking assistance for (choose one)

Troop Number

If adult, indicate your position/role be in the troop.

Program Grade Level

Full Name (one applying)

First NameLast Name

Current Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

County in which you reside

Parent/Primary Caregiver Name

First NameLast Name

Relationship to Girl (If applying for adult put self.)

Parent/Primary Caregiver Email Address

example@example.com

Parent/Primary Caregiver Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Total number of people in the household

Total number of dependents in) the household

Total number of adults in the household

Did the Girl Scout participate in the most recent Fall Product Program? (If applying for adult check adult.)

Did the Girl Scout participate in the most recent Cookie Program? (If applying for adult check adult.)

Did the Girl Scout earn Cookie Dough or Nutty Bucks? (If applying for adult check adult.)

If you answered yes to your Girl Scout earning Cookie Dough/Nutty Bucks how was it used?

If Girl Scout did not participate in one or both of the programs, please explain why.

Yearly Total Household Gross Income (Please include salaries, child support, social security, investments, state assistance, financial assistance, tanif, SSI, disability, all sources, etc.) We cannot accept $0 as household income.

Date of Application

Date

I certify that all information in this application is true and accurate to the best of my knowledge. This will be accepted as your signature. Any information not completed may mean your financial assistance may not be processed. The information provided in this application is strictly confidential and will be used solely for the purpose of evaluating for financial assistance.

Financial assistance is based on need. If you do not qualify for 100% fnancial assistance, payment is expected prior to processing of membership. We accept cash, check, and credit/debit cards, which can be paid to a staff member, the council offce, or by phone.

Signature/Name

First NameLast Name