2009 Girl Application for the South Carolina Girl Scout by jlesterback

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									                                       2009 Girl Application for the
                            South Carolina Girl Scout Legislative Page Program
Please type or print clearly and legibly. Fill out application completely. Return completed application to:
Kim Neel, Legislative Page Program, PO Box 200, Irmo, SC 29063 by November 1, 2008 with the $5.00 application fee.

Girl’s Name: _____________________________________________________________________________________
                   (Last)                                           (First)                                                     (Preferred name)

Home Address:                                     (Street, Apt.#)                                            (City)                     (Zipcode+4)

Present School Grade:               Telephone Number:                                  Email:___________________________________
                                                     (Best # to reach you. Area code and #)             (for all correspondence – OK to list more than one)

Council Name:                          Troop/Group #:                                          School: ______________________________

Please use an additional sheet of paper if necessary.
1. List any Girl Scout recognitions you have received in the last three years.

___________________________________________________________________________________________________________

2. List all of your extracurricular activities.

___________________________________________________________________________________________________________

3. List non-GS recognitions/ awards you have received since 8th grade not listed in above.

___________________________________________________________________________________________________________
4. List the name and date of all Destinations in which you have participated.

___________________________________________________________________________________________________________
5. List and briefly describe any training you have received through your Girl Scout Council or other community organization such as
Program Aide, L.I.T., First Aid certification, etc.

___________________________________________________________________________________________________________
6. List leadership roles/titles and the organization in the past 2 years.

___________________________________________________________________________________________________________
7. List your favorite service projects you have participated in during the past two years:

___________________________________________________________________________________________________________
8. Silver Award project summary (if earned):

___________________________________________________________________________________________________________
9. Gold Award project summary (if earned or if underway):

___________________________________________________________________________________________________________

Questions #10 and #11 are required information.

10. My House District Number is ____ Name of State House Representative: __________________________________________

11. My Senate District Number is ____Name of State Senator:______________________________________________________
If you do not know your representative or senator, go to http://www.scstatehouse.net/cgi-bin/zipcodesearch.exe and type in your zip code +4

12. Have you previously participated in the Girl Scout Page Program?                      No    Yes

**********************************************************************************************************************************************************
Council Staff: I verify that the above named applicant is a registered member of GSUSA. I further recommend them to serve and know that
they will set a good example and uphold the Girl Scout Promise and Law.

Council Staff Signature___________________________________________________________Date__________________________


KZN 8.14.08 South Carolina Girl Scout Legislative Page Program Application – Page One of One

								
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