Request for Volunteer Years of Service Pin (5, 10, 15 years)

Request for Volunteer Years of Service Pin

(5, 10, 15 years)
The Volunteer Years of Service Pin recognizes an adult member registered with Girl Scouts of the USA for her/his years of active adult volunteer service at five-year intervals. Only service years as an adult member are counted toward this recognition. This request is for service years totaling 5, 10, or 15-years.

*The Volunteer Years of Service Pin (5, 10, 15 years) is provided by the local Service Unit.
Today's Date *

Month Day Year
Candidate's Information:
Name *
Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone
Service Unit *
Troop/Group #
Email *
Nominee's Current Position
Is nominee a currently registered member?

Yes No Unsure
Please check one: *

5-year pin 10-year pin 15-year pin
Requestor's Information:
Name *

First Name Last Name
Email *

Confirmation Email
Thank you for your nomination and all you do for Girl Scouting!
Should be Empty: