Form 330f - Girl Financial Assistance Request Form - Girl Scouts Of Eastern Oklahoma


Girl Scouts of Eastern Oklahoma
This is confidential information. Form must be completed and signed by a Parent/Guardian.
INSTRUCTIONS: Type or print ALL the information requested. Incomplete forms will be returned. Submit the completed form to: Girl Scouts of Eastern
Oklahoma, Director of Programs, 4810 S. 129
E. Ave., Tulsa OK 74134, or email .
Girl’s Name ______________________________________________Troop # __________ # Years a Girl Scout __________
Parent/Guardian Name ______________________________ Parent Email________________________________________
Address _________________________________________City______________________________ Zip________________
Phone (h) _____________________________ (w) ____________________________ (c) ____________________________
Girl is a:  Daisy
 Brownie
 Cadette
 Senior
 Ambassador
TOTAL ANNUAL FAMILY INCOME (from all sources):
 Under $15,000
 $15,001-$25,000
 $25,001-$35,000
 $35,001-$45,000
 $45,001-$55,000
 $55,001-$75,000
 Over $75,000
Number of people supported by this income __________
Number of dependent children living at home __________
List any unusual or extraordinary family expenses or circumstances (unexpected medical expenses, job loss, etc.):
Girl participates in GS activities/meetings: All of the time
Some of the time
Participated in most recent Girl Scout Cookie Program? Yes No If no, why ____________________________
(Non-participation significantly impacts amount of financial assistance granted.)
(NOTE: Available Cookie Credit will be applied before Financial Assistance is granted)
Financial Assistance is needed for (Please specify):
 Uniform Components &/or Books – complete information on the back of this form.
 New Troop Start-Up - $10 (Available on a one-time basis for new troops only. Complete troop leader section below.)
 Council Activity, Event or Camp _______________________________ Dates _______________ Cost _______________
 GSUSA or Council Travel Opportunity __________________________ Dates _______________ Cost _______________
A maximum of ½ the total cost of transportation and event fees up to a maximum of $750.00 per trip may be awarded
to any girl for up to two travel opportunities – no more than one during a membership year (October-September).
Applicant is responsible for payment of deposits. Amount of assistance will be determined based on a calculation of
need. When applying for assistance for a GSUSA Travel Opportunity, attach a copy of the selection notification letter
that lists the dates of the event and the event fee. If for any reason you do not attend this event, all financial
assistance and cookie credit must be returned to Girl Scouts of Eastern Oklahoma.
Amount you can pay: $________________________
Amount you are requesting: $______________________________
Have you received financial assistance from Girl Scouts of Eastern Oklahoma in the past 12 months? ___________________
If yes, amount received and for what purpose? ______________________________________________________________
PARENT/GUARDIAN SIGNATURE_______________________________________________________________________
If assistance is being requested for New Troop Start-Up, the following information and the signature of the troop leader is required.
Check will be mailed to the troop leader
Troop Leader’s Name ___________________________________ Email__________________________________________
Address _________________________________________City______________________________ Zip________________
Phone (h) _____________________________ (w) ____________________________ (c) ____________________________
TROOP LEADER’S SIGNATURE_________________________________________________________________________
Although not required, partial or full reimbursement (when and if possible) of any funds granted is appreciated and accepted at any time by Girl Scouts of
Eastern Oklahoma. This enables GSEOK to continue to provide assistance for girls when the need arises. Reimbursements and donations may be sent to:
Girl Scouts of Eastern Oklahoma, Director of Programs, 4810 S. 129
E. Ave., Tulsa OK 74134.
OFFICE USE: Date Rec’d __________ Membership Registration Verified _______Activity Registration Verified _______
Worksheet Completed __________ Check Request/Voucher Completed _______ Notification sent to Parent _______
#330F 06/16


00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Page of 2