Financial Assistance Application Event/destination Form Page 2
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2Please answer each statement:
____ Yes
____ No
I participated in the last cookie sale program.
____ Yes
____ No
I participated in the last fall nut/candy sale program.
____ Yes
____ No
The troop is putting money toward this event.
____ Yes
____ No
My family is putting money toward this event.
Estimated Expenses:
Cost of event:
$_______
Total troop is paying:
-$_______
Total family/volunteer is paying:
-$_______
Total requested from GSCFP:
$_______
Reason for request. Please write clearly: (please provide as much information as possible)
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Household members: # adults______
#children ________
Please list total household income: _______________________________
Total Annual Household Income (pretax): Total all annual income from wages, unemployment benefits, child
support, social security, state aid and any other income. This should include income from all household members. A
copy of the first page of your most recent tax return must be included with each application or your request will
not be processed.
Signature of Applicant: _________________________________________ Date: __________________
Reminder: An incomplete application may not be processed. Therefore, complete all areas of application prior to
submitting for approval. If you are unsure of how to complete the application, please contact the Girl Scout
Council of the Florida Panhandle, Inc. at (850) 386-2131 or toll free at (800) 876-9704.
Return this form to:
Program Registration, Girl Scout Council of the Florida Panhandle, Inc.
250 Pinewood Drive, Tallahassee, FL 32303
For staff use only:
Date rec’d: _________________ Rec’d by: ______________________ Debtor with GSCFP: ____ Yes ____ No
Registration verified:
____ Yes
____ No
By: _________________________________
Amount approved: _________________________________
By: _________________________________
Notified By:
____ Letter
____ E-mail
____ Phone
By: ________________ Date: ____________
Girl Scout Council of the Florida Panhandle, Inc. 07/11
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