Program Assistance Grant Application Form - Girl Scouts Of Central Indian
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1
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3Program Assistance Grant Application
Girl Scouts of Central Indiana
Please complete the Program Assistance Grant Application online at ,
or mail the following form to Girl Scouts of Central Indiana, Suite 100, 2611 Waterfront Parkway East
Drive, Indianapolis, IN 46214.
Grants are given for individual girl or troop participation in Girl Scouts of Central Indiana and Girl Scouts of the
USA endorsed events such as GSUSA national and international Destinations, resident and day camp, and
council, service unit, or troop program activities. Grants are only given to registered Girl Scouts.
• Each girl may apply for one troop, one camp and one individual grant per year.
• Financing is seldom more than matching funds with the exception of extreme need and or unforeseen
circumstances beyond the control of the applicant.
• All applicants will be notified by mail as to the disposition of the requests.
The grant committee will look at the following factors when evaluating a grant request.
• The application request is based on a realistic goal and includes a sound financial plan.
• The financial resources of the applicant, including any special circumstances.
• The degree to which the applicant has used her own resources to help pay for the cost of the opportunity.
Type of PAG requested:
Troop (see section I)
Individual (see section II)
Camp (see section II)
Girl Scouts of Central Indiana should make PAG check payable to:
Section I: Troop PAG (circle appropriate grade level)
Girl Scout Daisy Girl Scout Brownie Girl Scout Junior Girl Scout Cadette/Senior/Ambassador
Troop number ____________Leader’s name _______________ Phone ( _____ ) ________________
Street address ______________________________________ # participating (G) _____ (A) _____
City, state, ZIP ___________________________________________ County ___________________
Are all girls are registered Girl Scouts?
Yes
No
I have reviewed the Safety-Wise section appropriate to this activity and assure that all requirements will be met.
Leader signature ________________________________________________ Date ______________
Troop PAG applicants please continue to section IV.
Section II: Individual PAG (circle appropriate grade level)
Girl Scout Daisy Girl Scout Brownie Girl Scout Junior Girl Scout Cadette/Senior/Ambassador
Girl’s name ___________________________________________ Troop number _______________
Street address ______________________________ City, state, ZIP __________________________
County/Service unit _______________________________ Phone ( ______ ) ___________________
Number of years in Girl Scouting _____Grade in fall ________________ Birth date _________________
Does girl receive free/reduced lunch at school?
Yes
No
Girl wishes to attend the following program activity: __________________________________________
Council program activity:
Troop program activity
Day camp
Resident camp
Girl signature ____________________________________________________ Date _____________
Parent name printed __________________________________________________________________
Parent/guardian signature __________________________________________ Date _____________
Camp applicants please continue to section III; individual applicants please continue to section IV.
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