Adult Education Scholarship Application for Adults
Financial assistance is available to volunteers who wish to take Adult Education courses that have a fee and are
supported and maintained by Girl Scouts of Eastern Missouri Adult Education Department. For example: First Aid,
CPR/AED, Wilderness and Remote First Aid, Cooking for Crowds at Camp, Troop Camp Certification Courses, Small
Craft Safety Training, and USA Level 1 Archery are eligible for a scholarship.
The Answer Center must receive this completed application via email before the course registration period ends.
Submit one application per adult per course. Eligibility rules apply to all applications. See details on page 2.
Full Name of Applicant ____________________________________________________________________________
Street Address ___________________________________________________________________________________
City _____________________________________________________________State __________ Zip _____________
Day Phone (______) _____________________________ Evening Phone (_____) ______________________________
Email ___________________________________________________________________________________________
I am a currently registered Girl Scout adult volunteer in District_______ Neighborhood______ Troop____________
Girl Scout volunteer role(s)_________________________________________________________________________
Number of individuals in your household: _______ Age of each dependent child in your household: _____________
Check the range of your total household gross income over the last year (include all sources of income such as
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
Last Girl Scouts of Eastern Missouri scholarship award received: Date: ______________ Amount: ______________
Are there any special circumstances we should consider with this financial assistance request?
Please complete the following about the learning opportunity that a scholarship is being requested:
Adult Education Course Name ______________________________________________________________________
Course Date ________________, Location ______________________________, and cost ______________________
All scholarships require that a portion of the program cost be paid by the member and/or troop. Please provide
the amount you can contribute at this time. You will be notified of your remaining balance due once the
scholarship award decision is finalized.
Personal Contribution: $____________________
Scholarship Amount Requested $____________________
Signature: ___________________________________________________________________ Date: ______________
For Office Use Only
Calc: ____________ Amt Approved: ________________ Due: ________________ Date Due: ________________ Emailed: ____
Task: ___ Processing Staff Initials: _________________ Approving Staff Initials: _________________ Date: ________________
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Adult Education Scholarship Application for Adults Guidelines
General Information
Financial need-based scholarships are available for those who do not have the funds to participate in a
Girl Scout Adult Education learning opportunity to ensure that these opportunities are accessible to all
adult volunteers.
Girl Scouts’ non-discrimination policy applies to the awarding of all Adult Education scholarships.
All details concerning financial assistance requests are kept confidential.
The applicant must be a registered Girl Scout member in Girl Scouts of Eastern Missouri
Applications must be received at the Girl Scout Service Center no later than the program registration
Applications must be signed.
Adult Education scholarships are non-transferable, valid only for the adult and specific course for which
they are awarded.
Applicants and/or households with outstanding balances are not eligible for scholarship assistance until
open balances are paid.
Financial Information
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 adult and/or troop.
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.
Submission Instructions
Submit the completed Adult Education Scholarship Application with the Course Registration form to the
Answer Center Girl Scout Service Center via email at answercenter@girlscoutsem.org
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.