Adult Promise Fund Application Form

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ADULT PROMISE FUND APPLICATION
PLEASE COMPLETE THIS FORM AND SUBMIT TO: GIRL SCOUTS OF GULFCOAST FLORIDA, INC.
4780 CATTLEMEN ROAD
SARASOTA, FL 34233
ATTENTION: MEMBERSHIP SPECIALIST
Girl Scouts of Gulfcoast Florida, Inc. maintains a Financial Assistance Fund which provides financial assistance to registered Girl
Scouts who, for whatever reason, find it difficult to pay for costs associated with Girl Scout membership and/or trainings.
FUNDS REQUESTED FOR: (PLEASE PRINT)
Name: _______________________________________________________________________ Home Phone: ________________________
Address: ______________________________________________________________________ Work Phone: __________________________
City: __________________________________ Zip: _________________________
Girl Scout position(s): _________________________________________________________________________________________________
Service Unit: __________ Troop #: __________
Briefly describe your participation in Girl Scout activities:
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
EXPLANATION OF FINANCIAL CIRCUMSTANCES THAT WARRANT THIS APPLICATION. PLEASE BE SPECIFIC.
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Has the council helped in providing financial assistance in the past?
Yes
No
List type of assistance you previously received: _________________________________________________________________________
Check box(es) for which you are requesting assistance:  
Training Registration
Membership Registration
Name of training opportunity: _________________________________________________________ Date:______/______/____________
Location: ___________________________________________________________________________ Cost: $_______________________
What portion are you willing or able to provide? $_________________
CONTRACT AGREEMENT:
By signing this Financial Assistance Application for training or certification, I agree to be available to assist in the area I
attended. This could be on a troop, service unit, county, or council level. Signature required to be processed.
_________________________________________________________
________/________/______________
Signature
Date
C:MyDocs\SHELFFORMS\2015Forms\Adult Promise Fund Application - Rev-6/15

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