Program Assistance Grant Application Form - Girl Scouts Of Central Indiana Page 2
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3Program Assistance Grant Application
Girl Scouts of Central Indiana
Section III: Camp PAG (circle appropriate grade level)
Submit a $10 deposit with your Program Assistance Grant application. The application will not be processed until the $10 fee has
been received by Girl Scouts of Central Indiana.
Girl Scout Daisy Girl Scout Brownie Girl Scout Junior Girl Scout Cadette/Senior/Ambassador
Parent/guardian name ________________________________________ Troop number ___________
Work phone ______________________________ Cell phone ________________________________
Complete only if different from girl’s information.
Street address ____________________________________________________________________
City, state, ZIP ________________________________ County/Service unit _____________________
Camp attending ______________ Camp dates __ Session number or name _____________________
School
________________________________________________________________________________
Camp applicants please continue to section IV.
Section IV: Event details and participation
Location ______________________________________Transportation _______________________
Detailed description of event __________________________________________________________
________________________________________________________________________________
Dates of trip ______________________________________________________________________
Have reservations been made?
Yes
No
q
q
What are your sleeping arrangements?
Tents
Hotel
Other
q
q
q
Do you have additional insurance other than Girl Scouts?
Yes
No
q
q
A complete itinerary must be submitted including dates, times, places and accommodations with a full list
of girls and adults.
Has troop/girl received a grant for a Girl Scout activity in the past year?
Yes
No
q
q
Did the troop/girl participate in the Fall Product Sale Program?
Yes
No
q
q
If no, why not? _____________________________________________________________________
Did the troop/girl participate in the Girl Scout Cookie Program?
Yes
No
q
q
If no, why not? _____________________________________________________________________
All applicants please continue to Section V.
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