Cookie Credits, Fall FUNds, and Juliette Program Credit Reimbursement Form

Complete this form to be reimbursed for Cookie Credits, Fall FUNds, and Juliette Program Credits used to help pay for event fees associated with:

Council-approved volunteer-led day camp
Community/area-sponsored encampments
Council-approved extended troop trips for Girl Scout Juniors, Cadettes, Seniors, and Ambassadors
Girl Scouts of the USA Destinations travel
Approved and completed Girl Scout Bronze, Silver, and Gold Award projects
Juliette Girl Scout activities

Questions? Contact us.

Please Note: No expired credits will be eligible for reimbursement. Cookie Credits and Fall FUNds expiration dates extend for two additional years if used for extended trip travel only. Make sure to keep copies of the form and receipts for your records.

Select one:*

Council-Approved Volunteer-Led Day Camp/Community/Area-Sponsored EncampmentHighest Award (Bronze, Silver, Gold Award) ProjectsJuliette Program ActivitiesExtended Troop/Juliette Trip, GSUSA Destinations Travel, or Council-Led Travel

For Council Approved Volunteer-Led Day Camp or Community/Area-Sponsored Encampment, Girl Scouts River Valleys recommends completing this form for program credits on a weekly basis to ensure funds are available. Paper Juliette Program Credits can be collected and submitted for reimbursement all at one time.

Name of Requestor*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address*

The email address entered will be emailed a copy of the form upon submission. Be sure to check your "Junk" folder.

Phone Number*

Please enter a valid phone number.

Girl Scout Name*

First NameLast Name

Girl Scout Name*

Troop or Juliette Number*

Community/Area Name or Number (Optional)

To look up your community/area name or number, see our Community Area Roster at gsrv.gs/roster

Position/Role*

Event/Project/Travel Name*

Event/Travel Location*

Event/Travel Dates*

Has a Travel Request Form been approved for this trip?*

YesNo

Approval Date of Travel Request Form

MonthDayYear

You can find the Travel Request Form at GirlScoutsRV.org/Travel-Planning.

Please provide an explanation/description of what the reimbursement request is being submitted for and a list of itemized expenses:*

Do you want to convert paper or Electronic Juliette Program Credits to your Juliette Program Credits card?*

YesNo

Are you a graduating Juliette?*

YesNo

Graduating Juliette requesting remaining funds be donated to:*

Girl Scouts River Valleys’ Family Giving Fund in support of general council operations.Girl Scouts River Valleys’ TroopGirl Scouts River Valleys’ Community/AreaNon-profit charity whose mission is in line with Girl Scout Values

Are you a Juliette Girl Scout transferring to a troop?*

YesNo

If yes, are you transferring your remaining Juliette Program Credits to your new troop?*

YesNo

Enter the Receiving Troop Number*

I understand that my Juliette Program Credits will be transferred to the troop account and will be used to benefit the whole troop.*

Yes, I understand

Enter the Receiving Community/Area Name or Number*

Is this for a Girl Scout activity?*

YesNo

Please provide an explanation/description of what the reimbursement request is being submitted for and a list of itemized expenses:*

Amount of Receipt(s) Submitted:*

This amount must equal or exceed amount of credits submitted.

Select the type of program credit you are submitting for Council-Approved Volunteer-Led Day Camp or Community/Area-Sponsored Encampment reimbursement.*

Cookie Credits, Fall FUNds, or Juliette Program CreditsHappy Camper Coupon (For Day Camp reimbursements only)Paper: Juliette Program Credits

Select the type of program credit you are submitting for Highest Award (Bronze, Silver, Gold Award) Project(s) reimbursement.*

Cookie Credits, Fall FUNds, or Juliette Program CreditsPaper: Juliette Program Credits

Select the type of program credit you are submitting for Juliette Program Activities reimbursement.*

Cookie Credits, Fall FUNds, or Juliette Program CreditsPaper: Juliette Program Credits

Select the type of program credit you are submitting for Extended Troop/Juliette Trip, GSUSA Destinations Travel, or Council-Led Travel reimbursement.*

Cookie Credits, Fall FUNds, or Juliette Program CreditsPaper: Cookie Credits or Juliette Program Credits

Please complete or upload the information for each Girl Scout that submitted their program credits:*

Please complete or upload the information for each Girl Scout that submitted their coupon:*

Upload a report with coupon and/or program credit card information for each Girl Scout that submitted their program credits.

Accepted file types: pdf, doc, docx, xls, xlsx, csv, txt, zip, jpg, jpeg, png, Max. file size: 50 MB.

Please select the year of the paper credit you will be mailing. (Select all that apply)*

2020 Cookie Credits (expire Sep. 15, 2024 for approved troop trips)

2020 Cookie Credits Dollar Amount*

Paper Juliette Program Credits Amount Submitted*

I understand that I will not receive a reimbursement until my paper program credits are received by Girl Scouts River Valleys.*

Yes, I understand.

Print the PDF copy of the completed reimbursement form attached to your email confirmation and mail along with the paper credits and receipts (if required) to:

Girl Scouts River Valleys
Attn: Reimbursement Form,
400 Robert Street South
St. Paul, MN 55107

Select which account to reimburse. All Automated Clearing House (ACH) processing can take up to four weeks.*

Day Camp Account Automated Clearing House (ACH) (Please allow four weeks for processing)Community/Area Account Automated Clearing House (ACH) (Please allow four weeks for processing)Troop Account Automated Clearing House (ACH) (Please allow four weeks for processing)Travel Organization Check (Please allow four weeks for processing)Parent/Guardian Reimbursement Option:Non-Profit Charity (For graduating Juliette only; Please allow up to four weeks for processing.)

Last four digits of day camp bank account number.*

This bank account can only be reimbursement for Volunteer-led Day Camps.

Last four digits of community/area bank account number.*

This bank account can only be reimbursement for Community/Area Encampments.

Last four digits of troop bank account number.*

This bank account can only be reimbursement for extended travel, Highest Awards projects, and Juliette-to-troop transfers. If you are unsure of the troop number please enter n/a.

Travel Organization Name*

(Please allow up to four weeks for processing)

Travel Organization Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Account Number with Travel Organization*

This will be included on the check for Travel Organization to know who to credit money.

Name on Account with Travel Organization*

This will be included on the check for Travel Organization to know who to credit money.

Select a preferred payment option for parent/guardian reimbursement:*

Check made payable to "Parent/Guardian" of "GIRL NAME" and mailed to address provided. (Please allow up to four weeks for processing)Automated Clearing House (ACH) (Please allow four weeks for processing)

Parent/Guardian Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emailed Address*

To contact for collecting account information.

Non-Profit Charity Name*

(Please allow up to four weeks for processing)

Non-Profit Charity Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Supporting Documents*

Accepted file types: doc, docx, jpg, jpeg, png, pdf, xls, csv, Max. file size: 40 MB.

Supporting Documents

Accepted file types: doc, docx, jpg, jpeg, png, pdf, xls, csv, Max. file size: 40 MB.

Please upload receipts, etc. For troop travel, please attach your completed Travel Request Form. This amount must equal or exceed the amount of credits submitted. (Accepted file types are: doc, docx, jpg, jpeg, png, pdf, xls, csv)

Entry Date

MonthDayYear

Cookie Credits, Fall FUNds, and Juliette Program Credit Reimbursement Form

Type of Reimbursement

General Information

Reimbursement Information