Form 330f - Girl Financial Assistance Request Form - Girl Scouts Of Eastern Oklahoma Page 2
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2Girl’s Name ________________________________________Troop # __________ Service Unit ______________________
UNIFORM COMPONENTS, INSIGNIA & BOOKS: (Please select only the items that are needed)
Tunic 6-7
8-10 $16.50
Daisy
XXS/XS S/M
Plus M $18.50
Vest
Regular X-Long $7.00
Brownie
Sash
Fee Total
S M L Plus S Plus M Plus L $19.50
Vest
$ __________
Regular
X-Long $8.00
Junior
Sash
M L XL 2X $20.50
Vest
Regular Plus size $9.00
Cad/Sr/Amb Sash
S M L XL 1X 2X 3X
Vest
$26.00
Uniform &
Council ID Set $5.50
Insignia Total
$2.25
Flag Patch
$
Troop Numerals 1 numeral $1.75
2 numerals $3.50
3 numerals $5.25
4 numerals $7.00
Girl’s Guide to Girl Scouting $19.50
Daisy
Journey Book $7.00 (specify title) ___________________________________________________
Girl’s Guide to Girl Scouting $19.50
Br. / Jr. /
Journey Book $7.00 (specify title) _______________________________________________
Cad. / Sr.
Skill-Building Badge Activity Set $4.00 (specify title) _______________________________
(Circle Level)
Book Total
Girl’s Guide to Girl Scouting $19.50
Amb.
$
Journey Book $7.00 (specify title) ___________________________________________________
CHECK PREFERRED
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_____ Merchandise will be picked up at the Girl Scout Store, 4810 S. 129
E. Ave., Tulsa.
DELIVERY
(Merchandise will be held for 60 days maximum.)
_____ Deliver merchandise to the service unit (list service unit name at top of page).
OPTION
_____ Ship merchandise directly to leader (Option available ONLY if outside the Tulsa Metro area
and if leader mailing address supplied on the front of form.)
FINANCIAL ASSISTANCE
This request for financial assistance has been reviewed and the following action has been taken:
$__________ Approved for New Troop Start-up Fee (A check has been requested to be sent to the troop leader.)
$__________ Approved for a GSUSA or Council Travel Opportunity (Check requested or funds applied to balance.)
$ __________ Approved for a Council Activity, Event, Camp (Funds have been applied to balance.)
$ __________ Approved for Uniform Components, Insignia, and/or Books.
$ __________ TOTAL approved
Explanation for denial or reduction:
Troop not eligible for “New Troop” Start-up Fees
Girl has adequate Cookie Credit that can be applied
Form was incomplete
Other: ____________________________________________
(Please provide missing information and resubmit request)
Staff Signature ____________________________________________ Date _________________________________________
Expires 60 days from date of notification.
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