Deadline for filing – December 1
Name of Nominee:
Street Address: City: State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip:
Submitted By:
Address:
Telephone: (day) (evening)
E-mail address:
Describe the volunteer work done and why it was outstanding.
Over what period of time did this occur?
Describe how this volunteer’s work significantly impacted membership growth and/or retention, fund development, or increased community visibility for Girl Scouting.
Which communities benefited from these contributions?
Does the nominee actively recognize, understand, and practice the Girl Scout values of inclusion? YES NO
How? How are you familiar with the nominee’s performance or contributions to Girl Scouting?
Is there any other information you would like to share about the nominee?
