Girl Scouts–North Carolina Coastal Pines
6901 Pinecrest Road
Raleigh, NC 27613
Girl Scout Gold Award Receipt of Contribution Form
Use the Receipt of Contribution form for grants, business/organization donations, and/or donations from
individuals when the amount exceeds $250.
All contributions are to be used specifically for the purpose of the Girl Scout Gold Award project.
All contributions must be recorded as income on the Girl Scout Gold Award Project Record of Income and
Expenses and submitted along with a complete accounting with receipts when submitting your final
Any contributions greater than $250 are to be sent to GS–NCCP along with the completed Receipt of
Contribution Form. It is important that you print legibly when completing the Receipt of Contribution
Form or the funds could be delayed in processing. After the contribution check is recorded, the funds will
be issued to the girl in a check made payable directly to the girl. Allow 3-5 days for processing.
Contribution checks should be made payable to Girl Scouts–North Carolina Coastal Pines and mailed
Girl Scouts–North Carolina Coastal Pines
Attention: Gold Award Funding Counselor
6901 Pinecrest Road, Raleigh, NC 27613
Any unused funds must be returned to GS–NCCP to be used to offset Girl Scout Gold Award program
administrative costs.
Name of Gold Award Candidate: ________________________________________________________________
Mailing Address: ____________________________________________ City: ___________________________
State: ______________________________ Zip: ________________ Phone: _____________________________
Date: ______________________________ Amount of Contribution: ___________________________________
Contribution Type
Grant Contribution
Business/Organization Contribution
Individual Contribution
Other (Please Specify) _________________________________________________________________
Name of Business, Organization, or Individual Contributor: ___________________________________________
Contact Name at Business/Organization: _________________________________________________________
Mailing Address: ____________________________________________ City: ___________________________
State: ______________________________ Zip: ________________ Phone: _____________________________
Email (optional): _____________________________________________________________________________
Has a “thank youbeen made? YES NO Date thank you was made/sent: ______________________
If yes, what type of thank you was made? Card Letter Verbal