Golden Trefoil Application - Troop
form #134a • 09/20 • page 1 of 3
The Golden Trefoil program denotes troop excellence throughout an entire member-
ship year. Use this form to help the girls in your troop track their progress. Please
have the girls in your troop complete the form and follow the instructions on the
third page to receive the Golden Trefoil patch for your troop. Find the Golden Trefoil
Application for Juliettes here.
Name
______________________________________________ Troop # ________________ Service Unit ____________
If your troop plans to earn this patch, we recommend you begin at the start of the Girl Scout year in October. Each year
a troop completes the requirements, they will be eligible to apply for an annual, color coded segment to accompany the
Golden Trefoil patch. Troops will be awarded Golden Trefoil patches at no cost to the troop if all criteria are met.
Note: Percentage of attendance is based on the number of girls registered with the troop at the time of the activity.
All of the following activities must be completed:
All members in your troop must have a current Girl Scout membership
At least 80% of the troop participated in Spring membership renewal
Troop financial report was completed and submitted by 6/30
The Girl Scout program supports the three leadership keys incorporating girl planning, keeping in mind the
Safety Activity Checkpoints and Council Volunteer Policies and Procedures. Please have a discussion with your
troop about the top three skills they learned, tried, or gained in the past year. Then, have the girls in your troop
give examples of how as a troop they incorporated the following:
DISCOVER: ____________________________________________________________________________
CONNECT:_____________________________________________________________________________
TAKE ACTION: __________________________________________________________________________
Volunteer Participation - 3 out of the 5 activities must be completed:
Created a year plan for troop in VTK
Attended a volunteer training in person
Completed online volunteer training
80% of service unit volunteer meetings were attended by a troop representative and communication was
maintained
Held at least 1 Parent/Guardian meeting
6 of the 11 activities listed below must be completed with 75% attendance:
Participated in a membership recruitment event or Girl Scout visibility event (ie. Bring a Friend event, tabling 1.
event, wear your uniform day, etc.)
Date _______________ What we did ____________________________________________________
Percentage of Girl Participation _____________ Percentage of Volunteer Participation ______________
Attended at least one council-sponsored activity or 2. Program Guide event
Date _______________ What we did ____________________________________________________
Percentage of Girl Participation _____________ Percentage of Volunteer Participation ______________
3. Attended at least one Service Unit-/Troop-hosted event
Date _______________ What we did ____________________________________________________
Percentage of Girl Participation _____________ Percentage of Volunteer Participation ______________
Participated in 4. both council-sponsored product programs
Fall Product Program sales: Troop/girl goal______________________ Was it reached?______________
* Troops who are not assigned a number prior to the Troop Qualification deadline do not need to complete this
step of the Golden Trefoil.
Girl Scout Cookie Program sales: Troop/girl goal _________________ Was it reached?______________
Took part in a Take Action project or Service Project5.
At Girl Scout property _____________________________________________
At a non-Girl Scout location_________________________________________
Percentage of Girl Participation _____________ Percentage of Volunteer Participation ______________
Participated in activities within three of the four program pillars6.
Outdoor____________________________ % Girl Participation _____ % Volunteer Participation _____
Life Skills ___________________________ % Girl Participation _____ % Volunteer Participation _____
STEM ______________________________ % Girl Participation _____ % Volunteer Participation _____
Entrepreneurship ____________________ % Girl Participation _____ % Volunteer Participation _____
Participated in a Girl Scout Ceremony (7. investiture/rededication, court of awards, formal flag ceremony, etc.)
Date _______________ What we did ____________________________________________________
Percentage of Girl Participation _____________ Percentage of Volunteer Participation ______________
Participated in a troop discussion about Highest Awards8.
Date _______________ Girl interest? ____________________________________________________
Percentage of Girl Participation _____________ Percentage of Volunteer Participation ______________
Participated in a troop discussion about travel goals9.
Date _______________ Girl interest? ____________________________________________________
Check all that apply:
Participated in Day Trip with troop
Participated in Overnight with troop
Made a plan for Future Travel with troop
Percentage of Girl Participation _____________ Percentage of Volunteer Participation ______________
The troop participated in a discussion/activity about the following 10. three special Girl Scout days:
Juliette Gordon Low’s birthday/Founders Day (October 31)
What we did
__________________________________________________________________________
World Thinking Day (February 22)
What we did
__________________________________________________________________________
Girl Scout Week/birthday (March 12)
What we did
__________________________________________________________________________
Golden Trefoil Application - Troop
form #134a • 09/20 • page 2 of 3
Steps to receiving your Golden Trefoil patches:
1. By 6/30: Complete this form in its entirety. When it is completed, coordinate a time with your service unit Girl
Experience Mentor (GEM) to discuss your troops’ progress, and to approve your completed form. (Note: if your
service unit does not have a GEM, please reach out to your service unit manager to have the form approved.)
Service Unit GEM ________________________________________________
Approved? __________________________ Date ______________________
2. Due 8/31: Submit this form by emailing the completed form to answers@girlscoutsosw.org. A GSOSW staff
member will process your application, and send the patches via mail to the address listed above.
If you have questions, please contact Girl Scouts at 800-338-5248 or email answers@girlscoutsosw.org.
Golden Trefoil Application - Troop
form #134a • 09/20 • page 3 of 3
Membership Year ____________ Troop # ____________ Service Unit # _______ Grade Level ________________________
Number of girls registered in troop by June 1 of current membership year __________
Name ______________________________ Phone_________________ Email___________________________________
Address
________________________________________ City ______________________ State _____ ZIP _________
Please indicate in the chart below the number of patches you need.
Patches earned this year (free)
Replacement patches (1st year $2 each; segments $.75 each)
# Golden Trefoil patches # Golden Trefoil patches
# 1st year segments - purple # 1st year segments - purple
# 2nd year segments - blue # 2nd year segments - blue
# 3rd year segments - green # 3rd year segments - green
# 4th year segments - yellow # 4th year segments - yellow
# 5th year segments - orange # 5th year segments - orange
# 6th year segments - red # 6th year segments - red
Total # of free patches:
Total cost of replacement patches:
11. Decided as a troop what new Outdoor skill you would like to work on this year
Outdoor Skill __________________________________________________________________________
Percentage of Girl Participation _____________ Percentage of Volunteer Participation ______________
0
0
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