Girl Scouts of the Missouri Heartland, Inc.
Volunteer Application
Please be sure to complete the following two pages fully.
Troop #
(All information will be kept confidential)
SU
Personal Information
Full Name _________________________________________ Preferred First Name ______________
Address __________________________________________________________________________
City _________________________________________________ State ________ ZIP ____________
Home Phone _________________ Cell Phone ________________ Work Phone _________________
E-mail Address _____________________________________________________________________
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Can you be called at work?
Yes
Work Extension ________
No
Girl Scout Interest Information/ Volunteer History
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Have you ever been a Girl Scout volunteer?
Yes
No
If yes, please list where, when, and position(s) held _________________________________________
__________________________________________________________________________________
Grade with which you would like to volunteer _______ School ________________________________
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Girl Scout position desired
Troop Leader
Troop Co-Leader
Other ___________________
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Have you ever been a member of or worked with other youth-related groups?
Yes
No
If yes, please list organization name(s), location(s), and date(s) _______________________________
_______________________________________________________________________________________________________________
Personal History
Answering “yes” to any of the following questions will not necessarily be cause for disqualification.
Have you or any member of your household ever been convicted of a criminal offense?
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Yes
No If yes, please explain: ____________________________________________________
Are you or any member of your household currently under treatment for drug abuse?
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Yes
No
If yes, please have the person in charge of your/their treatment write a statement in regard to the
appropriateness of working with or being around children at this time. Attach the statement to this application.
Have you, or any member of your household, ever been investigated for or convicted of child
abuse/neglect?
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Yes
No
Are you or any member of your household currently under treatment for anger management?
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Yes
No
If yes, please have the person in charge of your/their treatment write a statement in regard to the
appropriateness of working with or being around children at this time. Attach the statement to this application.
Have you or any member of your household been convicted of a sexual offense?
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Yes
No
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