Board of Directors - Girl Member Nomination Form

Board of Directors Girl Director-at-Large Nomination Form
This form must be submitted by 11:59PM on January 31, 2025.

Completed forms may be submitted by clicking "submit" below, or printing this form and upon completion delivering to:

Board Development Committee
Girl Scouts of North East Ohio
One Girl Scout Way
Macedonia, OH 44056-2156

or email: governance@gsneo.org
Candidate Information
First Name*
Last Name*
Home Address*
City*
Zip*
Home Phone
Mobile Phone
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).
Email*
School & Grade Level as of October 1, 2017*
Girl Scout Program Age Level*
Years in Girl Scouting*
Has the Girl Director-at-Large Position Description been reviewed with this individual and her parent/guardian and approval obtained prior to submission?*

YesNo

Girl Self Evaluation
Describe your involvement in Girl Scouts.*
Describe the characteristics you feel are most important in leadership.*
Why do you want to become a member of the GSNEO Board of Directors?*
If elected, how would you utilize your position to benefit the lives of girls?*

Please list any other extra-curricular activities you are involved in and what positions you hold, if any.
Organization 1 Name
Organization 1 - Number of Years Involved
Organization 1 - Positions held
Organization 2 Name
Organization 2 - Number of Years Involved
Organization 2 - Positions held
Organization 3 Name
Organization 3 - Number of Years Involved
Organization 3 - Positions held
Organization 4 Name
Organization 4 - Number of Years Involved
Organization 4 - Positions held
Additional Extra Curricular Activities? Attach a document showing organization name, years involved and positions held.

Upload a File

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Girl Candidate: I have received, reviewed and, if selected, I accept the responsibilities and commitments associated with service on the Board of Directors of the Girl Scouts of North East Ohio. I accept the expectations as outlined and agree to have my name entered into nomination for the terms indicated above.*

YesNo
Girl Digital Signature - I understand that my typed name serves as my digital signature.*
Type full name.
Parent/Guardian Permission: I am the legal parent/guardian of Girl Candidate and hereby give my permission for her, if elected, to serve on the GSNEO Board of Directors. I have reviewed the expectations outlined above and understand the associated time commitments, travel requirements and costs necessary for her to fulfill her responsibilities. We value girls’ honest feedback, and would like to let you know that we will be asking your daughter to share her opinions of this program with us. The following statements describe our policies around privacy and the use of collected information and data. These policies comply with The Children’s Online Privacy Protection Act (COPPA). (1) Your daughter’s survey answers will be for internal purposes only. (2) These surveys exist to help GSNEO understand program and policy effectiveness (3) Your daughter’s decision to participate in these surveys is completely voluntary. She does not have to participate if she does not wish to do so. (4) Your daughter’s decision to participate or not will not affect her standing in her Girl Scout sponsored program, and she will still be able to participate fully in all program activities. (5) If your daughter decides to participate, she can still choose not to answer any questions she does not want to answer, and may stop participation at any point. *

YesNo
Parent/Guardian Digital Signature - I understand that my typed name serves as my digital signature.*
Type full name.
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