Membership Delegate Nomination Form

Candidate Evaluation

When answering the questions below, please consider the Responsibilities, Qualifications and Position Description listed in the Girl Scouts of North East Ohio Membership Delegate Nomination Packet.
What knowledge, skills, or special qualities would the candidate bring to the role of Membership Delegate?*
What ideas does the candidate have for enhancing communication between the Council leadership and members?*
Please describe the candidate's Girl Scout experience, both current and past.*

Nominator Information
Nominator First Name*
Nominator Last Name*
Nominator Home Address*
Nominator City*
Nominator Zip*
Nominator Preferred 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).
Nominator Email*

Code of Conduct

As part of my responsibilities as a Membership Delegate and as a GSNEO Volunteer:
- I believe in and am committed to the mission, aims, and purposes of Girl Scouting.
- I am willing and able to devote sufficient time to planning and coordinating the duties of the position.
- I will demonstrate dependability, honesty, credibility, and resourcefulness.
- I will positively promote GSNEO’s programs, services, goals, and mission to the community-at-large.
- I will act in the best interest of GSNEO by conducting myself professionally and in accordance with the Girl Scout Promise and Law.
- I will maintain current knowledge of the Girl Scout National Program Portfolio, Volunteer Essentials, Safety Activity Checkpoints, and GSNEO Volunteer Policies.
- I will adhere to the GSNEO Bylaws and all policies of the Board of Directors.
- I will stay informed about what’s going on in the council, ask questions, request information, and actively participate in and take responsibility for issues, policies, and other matters referred to Membership Delegates by the Board of Directors and/or staff.
- I will actively participate in Membership Delegate conference calls/webinars in order to keep up to date on governance activities. If I am unable to participate in a call/webinar, I will contact the staff liaison to get the information.
- I will share information with my constituents in an accurate and timely manner.
- I will represent the viewpoints of both my girl and adult constituents with honesty, integrity, and an open mind. I will serve my constituents as a whole, rather than limit my representation to any special interest group(s).
- In accordance with my voting rights and responsibilities, I will attend all meetings of the General Assembly, as well as the Service Unit Membership Meeting for the Service Unit that I represent. I will read all pertinent information prior to the meeting.
In turn, the organization will be responsible to me to:
- Provide the tools and guidance necessary to fulfill my responsibilities.
- I will be sent, without request, governance and related information necessary to the fulfillment of my responsibilities.
- Opportunities will be offered to me to discuss governance matters and the organization’s goals, activities, and status; additionally, I can request such opportunities.
Volunteer Agreement
- I agree to meet the qualifications and fulfill the duties, expectations, and requirements as outlined above.
- I am a current registered member of GSUSA, and will maintain my membership for the duration of my term in this positon.
- If I am an adult, I am an approved volunteer, with a current GSNEO background check on file.
Full Name -- By entering my name and submitting this form, I agree with the conditions listed above for this volunteer position. I understand that my typed name serves as my digital signature.*

If the candidate is under the age of 18, permission must be obtained from her parent or guardian before having her name considered for election. If elected, the parent/guardian acknowledges that this position requires travel and agrees to assist the candidate in fulfilling the responsibilties of the position as described in the Membership Delegate Position Description, Expectations & Code of Conduct Agreement.

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 answers will be for internal purposes only.

(2) These and future surveys exist to help GSNEO understand program and policy effectiveness

(3) Your daughter’s decision to participate as a delegate and in future 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.
Parent/Guardian Full Name -- By entering my name and submitting this form, I agree with the conditions listed above for this volunteer position for my daughter. I understand that my typed name serves as my digital signature.*
Should be Empty:

	Always	Sometimes	Never
Candidate is able to remain objective and consider all viewpoints when making decisions and representing the best interests of the Council as a whole.
Candidate understands the role of governance and the decision-influencing system in the organization.
Candidate is able to communicate and work with a variety of people.
Candidate is willing and able to speak in front of small and large groups.