Juliette Fund Request

Juliette Fund Request

Girls participating in Girl Scouts as Juliettes earn Juliette Funds instead of Troop proceeds. These Juliette funds are managed by GSMW and not the individual girl or Juliette Mentor. A Juliette may use this Juliette Fund Request form to request funding for program materials, uniform pieces, badges/awards, membership fees, camp registration, or program registration.
JULIETTE GIRL DETAILS
Girl Name*

First NameLast Name
Age*
# of Years in Girl Scouts*
Girl Scout Level*
Product Program Participation
I participated in the last Cookie Program*

YesNo
If Yes: Total Boxes Sold
I participated in the Fall Nut & Magazines Program*

YesNo
If Yes: Total Amount ($) Sold
JULIETTE MENTOR DETAILS
Juliette Mentor*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Requesting Juliette Funds for the following:*

Council Store ItemsGSMW Program/Camp RegistrationGSUSA Membership RenewalReimbursement Request

Council Store Item(s) Request

Please list the items that you are requesting from the GSMW Store. If you aren't sure of the details required, please visit the GSMW Online Shop.

OPTIONAL: If you have more than 10 items, please upload a document listing the additional items using the same format listed above and please include them in the total cost below.

Browse Files

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Total Cost for Council Store Items*
Shipping & Handling*
SEE SHIPPING RATE CHART AT RIGHT

GSMW Sponsored Program / Camp Registration Funding Request

If your Juliette will be attending a Summer Resident Camp, please first register your Juliette paying the $50 deposit to secure her spot. Then use this form to request the amount of funds you want to use to pay towards the remaining balance. You can also request to be reimbursed the $50 deposit.

If you are requesting funds to register for a GSMW Sponsored Program, please provide the program details below so we can regsiter your Juliette. You will receive an email confirmation once registered.

If your Juliette would like to attend a SU event, please let the SU know she plans on attending and you can use this form to request the registration fee be sent to the SU.

If you would like to use Juliette Funds for an out of council program, please register your Juliette and use this form and your receipt to request a reimbursement.
Type of Program*

GSMW Sponsored ProgramSummer Resident CampSU EventOther
Program / Camp Name*
Location*
Start Date*

MonthDayYear
Date
Cost*
If requesting funds for a SU Event, please let us know who to send the registration fee to.

GSUSA Membership Renewal

If you are requesting to renew membership(s), please complete the section below.
I am requesting funds for membership for the following individuals.*

Juliette GirlJuliette Mentor
Membership Year*

Current Year Membership (Oct. 1 - Sept. 30)Next Membership Year (available Apr. 1 -Sept. 30)

Reimbursement Request
What was this purchase for?*

Community Service ProjectOther
Total Cost*
Receipt Upload

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If you have trouble, please email your receipt to customercare@gsmw.org. Cancelof
Reimbursement Check

Please allow 4-6 weeks for your reimbursement check.
Check Written To*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Reimbursement Request