Bronze Award Recipient Report Form

Bronze Award Reporting Form

Date of Bronze Award completion:

Date

NOTE: If you’d like to order a regular or higher-priced Bronze Award for your girls, be sure to place your order directly with the GSNEO retail store. Your order can be shipped to another receiving store other than Macedonia if needed.

Bronze Award Girl Scout Information:

I am a Juliette

5-digit troop number*

Name of Journey completed*

Troop volunteer first name*

Troop volunteer last name*

Troop volunteer e-mail*

street address*

city*

state*

zip code*

phone number*

By checking this box, I consent to receive customer care and account notification text messages (SMS or MMS) from Girl Scouts of North East Ohio. You may opt-out at any time by replying STOP. For assistance, text HELP. Message frequency varies. Message & Data rates may apply. View TERMS (gsneo.org/terms) and PRIVACY (gsneo.org/privacy).

Community advisor's first name*

Community advisor's last name*

Collaborating agency

Community advisor's e-mail*

street address*

city*

state*

zip code*

phone number*

By checking this box, I consent to receive customer care and account notification text messages (SMS or MMS) from Girl Scouts of North East Ohio. You may opt-out at any time by replying STOP. For assistance, text HELP. Message frequency varies. Message & Data rates may apply. View TERMS (gsneo.org/terms) and PRIVACY (gsneo.org/privacy).

Bronze Award Girl Scouts

Girl troop members - List all girl troop members that received the Girl Scout Bronze Award with this project.

Bronze Award Girl first name*

Bronze Award Girl last name*

Bronze Award Girl Scout 2 first name*

Bronze Award Girl Scout 2 last name*

Bronze Award Girl Scout 3 first name*

Bronze Award Girl Scout 3 last name*

Bronze Award Girl Scout 4 first name*

Bronze Award Girl Scout 4 last name*

Bronze Award Girl Scout 5 first name*

Bronze Award Girl Scout 5 last name*

yesno

Bronze Award Girl Scout 6 first name

Bronze Award Girl Scout 6 last name

Bronze Award Girl Scout 7 first name

Bronze Award Girl Scout 7 last name

Bronze Award Girl Scout 8 first name

Bronze Award Girl Scout 8 last name

Bronze Award Girl Scout 9 first name

Bronze Award Girl Scout 9 last name

Bronze Award Girl Scout 10 first name

Bronze Award Girl Scout 10 last name

yesno

Bronze Award Girl Scout 11 first name

Bronze Award Girl Scout 11 last name

Bronze Award Girl Scout 12 first name

Bronze Award Girl Scout 12 last name

Bronze Award Girl Scout 13 first name

Bronze Award Girl Scout 13 last name

Bronze Award GirlS Scout 14 first name

Bronze Award Girl Scout 14 last name

Bronze Award Girl Scout 15 first name

Bronze Award Girl Scout 15 last name

yesno

Bronze Award Girl Scout 16 first name

Bronze Award Girl Scout 16 last name

Bronze Award Girl Scout 17 first name

Bronze Award Girl Scout 17 last name

Bronze Award Girl Scout 18 first name

Bronze Award Girl Scout 18 last name

Bronze Award Girl Scout 19 first name

Bronze Award Girl Scout 19 last name

Bronze Award Girl Scout 20 first name

Bronze Award Girl Scout 20 last name

Take Action Project Team

Team Members - Must list at least 2 team members and information.

team member 1 first name, last name*

How do you know them?*

role*

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team member 2 first name, last name*

How do you know them?*

role*

yesno

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team member 3 first name, last name

How do you know them?

role

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team member 4 first name, last name

How do you know them?

role

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team member 5 first name, last name

How do you know them?

role

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team member 5 first name, last name

How do you know them?

role

------------------------------------------------------------------------------------------

team member 6 first name, last name

How do you know them?

role

------------------------------------------------------------------------------------------

team member 7 first name, last name

How do you know them?

role

Take Action Project Title

start date*

Date

end date*

Date

# Hours completed*

Brief description of Take Action Project (500 words max.)*

Share with others! Please consider answering the questions below. These questions help GSNEO share your project with other Girl Scouts and the community. The questions below also highlight your hard work becoming a Bronze Award Girl Scout!

How did you connect with your local and global communities?

What impact did your project have on your community?

THANK YOU: Your information will be submitted to the Girl Experience Department. Requests received will be mailed out on the 15th of every month. If you have questions about your request, email customercare@gsneo.org and place "Bronze Award Girl Scout Report Form" in the subject line.