GSUSA Life Saving Award Nomination Form

GSUSA Life Saving Award Nomination Form

Use this form to nominate a GSOFCT youth member for a GSUSA Life Saving Award (Bronze Cross or Medal of Honor).
The youth must be a registered Girl Scout at the time of the rescue. (No award is given to adults.)

It is important that the documentation process begin immediately after the rescue and proceed as quickly as possible. Applications for Lifesaving Awards must be requested within 60 days of the incident and submitted within six months after the accident occurred. The decision to recommend a youth member for an award must be reached no longer than six months after the event. This recognition requires approval from GSUSA.
- Application form must be completed giving full details of the incident.
- Application must be accompanied by a personally signed statement from
  - the rescuer
  - the rescued person
  - the witnesses (not more than three)
- Each statement must describe the details of the rescue as the person making the statement recalls them.
- Application must be signed by the adult volunteer.
- Application must be approved by the council before being submitted to GSUSA.
The recognition will be honored at the GSOFCT Annual Meeting and Recognition event. Held annually in late April/early May.
Submission Date*

MonthDayYear
Date
Rescuer Information

Information for the youth you are nominating.
Rescuer's Name*

Rescuer's First NameRescuer's Last Name
Rescuer's Email Address*
example@example.com
Rescuer's Troop Number *
Please enter the 5 digit troop # if not a member of a troop please enter 00000
Rescuer's Service Unit Name*
Service Unit Name (if unsure of the SU please enter the town the nominee resides in)
Nominator Information

Nominations can be submitted by anyone OTHER than the nominee. This includes other GSOFCT volunteers, council staff, Girl Scout family members, Girl Scouts, and more. The person submitting the nomination does not need to be a registered member of GSOFCT. Individuals CANNOT nominate themselves for recognition.
Nominator's Name*

Nominator's First NameNominator's Last Name
Nominator's Email Address*
example@example.com
Nominator's Troop Number *
Please enter the 5 digit troop # if not a member of a troop please enter 00000
Nominator's Service Unit Name*
Service Unit Name (if unsure of the SU please enter the town the nominee resides in)
Nomination Details

Nominations are required for all recognitions and are separate from any required endorsements.
Which GSUSA Lifesaving Award are you nominating the youth for?*
Medal of Honor: Lifesaving Award

Description:

Given for saving life or attempting to save life WITHOUT risk to the candidate’s own life. Lifesaving Awards are national awards given to a registered Girl Scout who has saved or attempted to save human life under circumstances that indicate heroism or risk of her own life. These awards are reserved for those Girl Scouts who have performed heroic acts beyond the degree of maturity and training to be expected at their age.

Criteria:
- The youth member must be a registered Girl Scout at the time of the rescue. (No award is given to adults.)
- Awards are given for saving, or attempting to save, human life only.
- A youth who has caused or contributed to the circumstances necessitating the rescue is automatically ineligible.
- Consideration of the youth is paramount. The acclaim accompanying such an award might even be detrimental. If the rescue (or attempted rescue) has been a particularly harrowing experience or publicity is not desired, it might not be appropriate to give an award.
- Parents, friends, and teachers should be helpful in making a wise decision.
If a youth member meets the above criteria, then the following should be considered in determining whether their act of rescue merits a lifesaving award:
- Age, maturity, and training of the girl, as well as that of the person(s) rescued.
- Degree of difficulty of the rescue.
- Nature of risk to the youth member’s life.
- Degree of danger to the life of the person(s) being rescued.
- Amount of assistance received from others.
- Whether first-aid and emergency-care procedures or proper techniques for water, ice, or fire rescue were used.
- Extent of good judgment shown by rescuer.
- Circumstances surrounding the incident (e.g. site, weather).
- Rescuer’s compliance with principles and standards outlined in Safety Activity Checkpoints
Pre-Requisites/Nomination/Endorsements:

It is important that the documentation process begin immediately after the rescue and proceed as quickly as possible.

Applications for Lifesaving Awards must be requested within 60 days of the incident and submitted within six months after the accident occurred. The decision to recommend a youth member for an award must be reached no longer than six months after the event.
Bronze Cross

Description:

Given for saving life or attempting to save life WITH risk to the candidate’s own life. Lifesaving Awards are national awards given to a registered Girl Scout who has saved or attempted to save human life under circumstances that indicate heroism or risk of her own life. These awards are reserved for those Girl Scouts who have performed heroic acts beyond the degree of maturity and training to be expected at their age.

Criteria:
- The youth member must be a registered Girl Scout at the time of the rescue. (No award is given to adults.)
- Awards are given for saving, or attempting to save, human life only.
- A youth who has caused or contributed to the circumstances necessitating the rescue is automatically ineligible.
- Consideration of the youth is paramount. The acclaim accompanying such an award might even be detrimental. If the rescue (or attempted rescue) has been a particularly harrowing experience or publicity is not desired, it might not be appropriate to give an award.
- Parents, friends, and teachers should be helpful in making a wise decision.
If a youth member meets the above criteria, then the following should be considered in determining whether their act of rescue merits a lifesaving award:
- Age, maturity, and training of the youth, as well as that of the person(s) rescued.
- Degree of difficulty of the rescue.
- Nature of risk to the youth member’s life.
- Degree of danger to the life of the person(s) being rescued.
- Amount of assistance received from others.
- Whether first-aid and emergency-care procedures or proper techniques for water, ice, or fire rescue were used.
- Extent of good judgment shown by rescuer.
- Circumstances surrounding the incident (e.g. site, weather).
- Rescuer’s compliance with principles and standards outlined in Safety Activity Checkpoints
Pre-Requisites/Nomination/Endorsements:

It is important that the documentation process begin immediately after the rescue and proceed as quickly as possible. The decision to recommend a youth member for an award must be reached no longer than six months after the event.
Please provide a 1-2 sentence description of the type of incident and actions taken by the Girl Scout rescuer, such as rendering lifesaving aid (CPR, abdominal thrusts) and/or conducting a lifesaving rescue (fall, fire, auto, hiking/outdoor). Important Tips: Use facts, not feelings. Be specific. Please provide evidence and examples.*

Endorser Information

Endorsements are separate from and in addition to the nomination. Endorsers must differ from the original nominator and cannot be from the nominee. Endorser should be the rescued person and any witnesses. No more than 3 endorsements should be submitted for these awards.
Endorser #1-The Rescuer*

Endorser #1 First NameEndorser #1 Last Name
Endorser #1 Email*
example@example.com
Endorser #2-The Rescued Person*

Endorser #2 First NameEndorser #2 Last Name
Endorser #2 Email*
example@example.com
Endorser #3-The Witness

Endorser #3 First NameEndorser #3 Last Name
Endorser #3 Email
example@example.com
Alternate Endorser

Alternate Endorser First NameAlternate Endorser Last Name
Alternate Endorser Email
example@example.com

Official GSUSA Nomination Form

Please complete the attached application and include it with your form submission. Please also include narrative statements from the rescuer, the rescued person and any witnesses. Submissions received without a completed form and/or narrative statements will not be reviewed or accepted.
Please upload the completed application as well as the narrative statements from the rescuer, the rescued person and any witnesses.*

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GSUSA Life Saving Award Nomination Form

Rescuer Information

Nominator Information

Nomination Details

Endorser Information

Official GSUSA Nomination Form