Program/Event Financial Aid Application

Any youth who is a registered Girl Scout living in one of the 19 counties that GSNorCal serves is eligible to receive need-based financial aid. This application only needs to be submitted once per membership year (October 1^st- September 30^th) or if your financial circumstances change significantly. One application per Girl Scout youth. Financial Aid is for youth participants only. Please Note: There is a separate financial aid process for summer camps.

Girl Scouts' Full Name: *

Street Address *

Address Line 2

City *

County *

State

Zip Code

Birthday * +

School Grade (as of Fall): *

Currently registered Girl Scout? *

Yes

No

If yes, enter troop #:

or Juliette (individually registered girl scout)

Is Girl Scout a foster child?

Yes

No

Parent/Guardian #1 Full Name: *

Phone: *

Email: *

Source of Income: *

If not applicable, please explain:

Parent/Guardian #2 Full Name:

Phone:

Email:

Source of Income:

If not applicable, please explain:

Girl Scout lives with: *

Parent/Guardian #1

Parent/Guardian #2

Both

Other Guardian

If other, please specify:

Please indicate any special circumstances related to this Financial Aid request:

Number of child dependents living at home: *

Number of adults dependent on family income: *

Annual household income: *

Do you want to apply your Council Credit/Cookie or Fall Rewards towards a program? *

Yes

No

If yes, please provide your Council Credit/Cookie Rewards number

Enter amount you would like to use

I am requesting financial aid for: *

Council Program/Event/Activity

GSUSA Destination

Council-organized Travel

Please write the name of the program(s) you are applying for: *

The amount of assistance varies for GSUSA Destinations. Council-Organized Travel awards are limited to lesser of 50% of the Total Cost or $1,000.00. Financial aid is not available for troop-organized travel.

Funding Release and Signature

I certify that all the information on this application and the supporting documents are true and complete.

Electronic Signature: By typing my name on this form, I am entering my "electronic signature" (as defined in The California Uniform Electronic Transactions Act 1633.1 - 1633.17) and certifying that I have read, fully understand and accept all terms of this agreement.

Parent/Guardian Signature: *

Date: * +

PLEASE ALLOW UP TO 7 BUSINESS DAYS FOR APPLICATION PROCESSING. ALL INFORMATION ON THIS APPLICATION IS TREATED CONFIDENTIALLY. GIRL SCOUTS OF NORTHERN CALIFORNIA RESERVES THE RIGHT TO REQUEST ADDITIONAL FORMS UPON APPLICATION REVIEW.

*REQUIRED FIELD

Questions? Email us at info@gsnorcal.org or by phone at 800-447-4475.

Program/Event Financial Aid Application

Funding Release and Signature

Published 9/5/2024