Fillable Activity Scholarship Application for Girls (Girl Scouts of Eastern Missouri)

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Activity Scholarship Application for Girls (Girl Scouts of Eastern Missouri)

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JT Rev. 3/18
Activity Scholarship Application for Girls
Instructions (see detailed guidelines on next page)
1. Submit one application per girl per activity.
2. Allow a minimum of three weeks for processing.
3. Application must be completed entirely and signed by a parent or guardian to be considered.
4. Eligibility rules apply to all applications, see details on page 2
5. Contact the Answer Center with any questions at 314.400.4600 or answercenter@girlscoutsem.org.
1. Full name of girl: Current Grade:
Address:
City: State: Zip:
Day Phone: Evening Phone:
Adult Email:
2.
Parent/Guardian Full Name Occupation Employer
Parent/Guardian Full Name Occupation Employer
3. Total People in Household: Ages of each Dependent Child in Family:
If you have other children applying for a scholarship, please list their names:
4. Please indicate which product programs the applicant has participated in within the last year:
Fall Product program Cookie program Neither, please explain:
5. Check the range of your total household gross income over the last year (include all sources of income, pre-
tax, such as employment, child support, unemployment, disability, social security, public assistance, etc.):
$0 - $19,999
$40,000 - $49,999
$70,000 - $79,999
$100,000 - $109,999
$20,000 - $29,999
$50,000 - $59,999
$80,000 - $89,999
$110,000 - $119,999
$30,000 - $39,999
$60,000 - $69,999
$90,000 - $99,999
Over 120,000
6. Last Girl Scouts of Eastern Missouri scholarship award received: Date: Amount:
7. Is there a special circumstance you would like us to consider when processing this request?
8. Activity for which a scholarship is being requested (a separate form is required for each activity):
Name of activity (program/camp/event):
Date(s) of activity:
Cost of activity or program: $
9. All scholarships require that a portion of the program cost be paid by the girl’s family and/or troop. Please
enclose the amount you can contribute at this time. You will be notified of your remaining balance due once
the scholarship award decision has been finalized.
Amount enclosed: $
Scholarship amount requested: $
Signature of Parent or Legal Guardian: Date:
For Office Use Only
Calc:____________ Amt Approved:$________________ Due:$________________ Date Due:________________ Emailed Task
Processing Staff Initials:________________ Approving Staff Initials:________________ Date:________________
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Activity Scholarship Guidelines
Scholarships are not available for:
• Adult participation in girl events
• Awards or insignia
• Books and materials
• District or neighborhood travel
• Out of Council Girl Scouts
• Troop camping
• Troop dues
• Troop travel
• Uniform items
4. Financial information
• Scholarships are awarded on an individual basis based on family need, and are not designed to underwrite
event costs for an entire troop.
• Award calculations are based on financial need and the Federal Poverty Level.
• Scholarships are designed to supplement individual family resources, not replace them. A portion of the cost
must be paid by the girl’s family and/or troop. Any amount contributed allows us
to serve more girls.
• Product programs help offset the costs of activity scholarships; girl participation will be taken into consideration
when awarding financial assistance.
• Additional information may be required to process each request, potentially including a phone interview, proof
of income, and/or proof of dependents.
• Scholarships are not retroactive; if payment was already received prior to scholarship application, the
scholarship will be nullified.
5. Submission instructions
• Submit completed Activity Scholarship Application form with the activity registration form to the Girl Scout
Service Center, unless the following exceptions apply:
• For district and neighborhood events, the scholarship application is sent to the Service Center, but the
program registration form must be sent to the event registrar (not Council).
• For resident camps with a deposit, reserve the desired camp online (a $50 deposit is required), then
mail the Scholarship Application to the Girl Scouts of Eastern Missouri Service Center at address:
2300 Ball Drive, St. Louis, MO 63146. For resident camps with no deposit, the application should be
sent prior to payment.
6. Scholarship notification
• Once a scholarship award decision has been finalized, the applicant will receive an email with the award
amount and amount still due, including a deadline for payment.
• Any balance due must be paid by the deadline given, or the scholarship will be forfeited.
Contact the Answer Center at 314.400.4600 or answercenter@girlscoutsem.org with any questions
1. General information
• Financial need-based scholarships are available for girls who do not have the funds to participate in a Girl
Scout program, to ensure that programs and camps are accessible to all girls.
• Girl Scouts’ non-discrimination policy applies to the awarding of all Activity Scholarships.
• All details concerning financial assistance requests are kept confidential.
2. Eligibility
• The applicant must be a registered Girl Scout member in Girl Scouts of Eastern Missouri and accepted into a
program before activity scholarship application is considered.
• Activity scholarships are only available for events or programs with registration fees of more than $10.
• Applications must be received at the Girl Scout Service Center no later than the
program registration
deadline
• Applications must be signed by the applicant’s parent or legal guardian.
• Activity scholarships are non-transferable, valid only for the girl and specific program for which they are
awarded.
• Applicants and families with outstanding balances are not eligible for scholarship assistance until open
balances are paid.
• All girls are subject to an activity scholarship maximum of $150 per year per Girl Scout for all programs and
camps except resident camp, council travel and destinations.
• Resident camp: limited to one resident camp per girl per year.
• Council travel programs: limited to one trip per girl per year.
• destinations: limited to one destinations scholarship in a girl’s entire Girl Scout career. These
scholarship applications may require additional supplemental information.
3. Activity scholarships are available for registration fees for girl participants for the following:
• Council sponsored programs and camps
• District or Neighborhood events, within council jurisdiction
• destinations
BS Rev. 7/20
SEL Rev. 2/20
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Activity Scholarship Application for Girls (Girl Scouts of Eastern Missouri)

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Completed 9 May 2021

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