Council Name:
Submit the original completed form to your council. Make copies for your Girl Scout Gold Award
project advisor and you to keep.
Your Information
Street Address:
City: State: Zip Code:
Email: Phone:
Age: Graduation Date: School:
Troop/Group Number: Troop/Group Volunteer:
Troop/Group Volunteer’s Phone: Email:
Girl Scout Gold Award Project Advisor:
Project Advisor’s Organization:
Project Advisor’s Phone: Email:
Your Team
List the names of individuals and organizations you worked with on your Take Action project.
Individual (if applicable) Organization Team Role
Girl Scout Gold Award | Final Report
Your Name:
Take Action Project
Project Title:
Start Date: Completion Date: Hours:
Please select which, if any, of the following four national program pillars your project most closely
addresses. (You may select more than one.) If necessary, check “Other” and elaborate.
Ǔ STEM: Discover all about engineering, computer science, and outdoor STEM through programming that will
ignite your interest and increase your condence and competency in STEM.
Ǔ Outdoor: Our progressive programs let you experience the outdoors as you build your skills and participate in
adventure opportunities that, eventually, will help you become a thoughtful and caring environmental steward.
Ǔ Life Skills: Civic engagement, healthy living, communication, nancial literacy, cultural arts, global
citizenship... You’ll gain skills in these important areas and more, enhancing what you’ve learned in
school and preparing you to succeed in the world.
Ǔ Entrepreneurship: Starting with the iconic Girl Scout Cookie Program, you can change the world by learning
business skills and exploring a variety of entrepreneurial opportunities, including social entrepreneurship.
Ǔ Other:
A. Summarize your project in 200 words or less. What did you do and why?
B. Further describe the issue your project addressed, the impact your project had, and who benetted.
C. What is the root cause of the issue your project addressed?
D. How will your project be sustained beyond your involvement?
Girl Scout Gold Award | Final Report
Your Name:
E. Explain the national and/or global link to your project (e.g., a project that seeks to improve local water
use practices addresses an issue with global implications, because water use poses a serious challenge
to sustainable development worldwide).
F. Describe any obstacles you encountered and what you did to overcome them.
G. Describe how you shared your project to inspire others (e.g., website, blog, presentations, posters,
videos, articles).
H. Describe what you learned from this project, including the leadership skills you developed. What did
you learn about yourself as a result of your project?
I. What was the most successful aspect of your project?
J. What about your project would you change or do differently if you could start over?
Girl Scout Gold Award | Final Report
Your Name:
Impact Chart
Using the below chart, describe the impact your project has had and will potentially continue to have on
your community, your target audience, and you.
Impact On... Goals Immediate Impact Possible Future Impact
Community What community issue was
What are concrete examples
that show your project made
a difference?
What examples of project
impact might you see in the
Target Audience
(e.g., workshop participants,
other youth, community
What skills, knowledge, or
attitudes did your target
audience gain?
What examples demonstrate
that the target audience
gained skills or knowledge?
What are some examples of
potential long-term impact
on your target audience?
Girl Scout Gold Award | Final Report
Your Name:
Continued . . .
Impact On... Goals Immediate Impact Possible Future Impact
You Which of the ve Girl Scout
leadership outcomes do you
think you were able to develop
through this project?
I have confidence in myself
and my abilities, and I have
formed a positive self-identity.
I act ethically, honestly,
and responsibly, and show
concern for others.
I take appropriate risks, try
things even if I might fail, and
learn from mistakes.
I develop and maintain
healthy relationships by
communicating my feelings
directly and resolving
conflicts constructively.
I desire to contribute to the
world in purposeful and
meaningful ways, learn how
to identify problems in the
community, and create
“action plans” to solve them.
Based on the outcomes you
selected, please provide one
or two examples of your
growth as a leader.
How do you think your
leadership skills will grow in
the future because of this
Girl Scout Gold Award | Final Report
Your Name:
Your Signature: Date:
Project Advisor’s Signature: Date:
Council Representative’s Signature: Date:
Interested in a $15,000 college scholarship? Just copy and paste the content from your project proposal
and final report forms into Go Gold Online and let your council know you’d like to apply for the honor of
National Young Woman of Distinction. Applications are accepted by councils April 1–30. Visit our NYWOD
page for more information, and check out additional scholarship opportunities.
Girl Scout Gold Award | Final Report
Your Name:
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