Thanks Badge Pin Nomination Application Form Page 2

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THANKS BADGE PIN NOMINATION APPLICATION
Questions that appear on endorsement questionnaire:
The endorsement should address the following questions and provide relevant facts, specific actions, measurable
impact and particular behaviors that show the service provided exceeded the expectations of their position.
1.
How did you become aware of the candidate’s accomplishments?
2. Please describe in detail what the candidate did to merit this award (refer to requirements) and the measurable
impact their service has had to Girl Scouting. Include service provided for at least the past four years.
3. How did the candidate demonstrate inclusive behavior?
4. Please provide details on how the candidate provided exemplary service in a leadership role, resulting in a
measurable impact that benefits the Girl Scout Movement. Who was affected by the candidate’s service?
How were they affected?
Endorsement questionnaire writers:
It is the responsibility of the nominator to make sure the required endorsement questionnaire is submitted with this
nomination application.
Name: ________________________________________ Email: ____________________________________________________
Thanks Badge requires one questionnaire.
Designated Contact Person:
If approved, who should be notified?
Name: ________________________________________________ Date of event: _____________________________________
Complete address: _______________________________________________________________________________________
Day Phone: ______________________________________ Alternative phone: _______________________________________
Email: ___________________________________________________________________________________________________
SEND COMPLETED APPLICATION AND ENDORSEMENT QUESTIONNAIRE
By Email:
One candidate nomination per email
Attach nomination application and required endorsement questionnaire to email (must be submitted
together)
Include candidate name and award in subject line of email
Send nomination to
By Fax: Adult Awards at 651-227-7533
By Mail:
River Valleys Adult Awards and Recognitions
Girl Scouts of Minnesota and Wisconsin River Valleys
400 Robert Street South
St. Paul, MN 55107
Questions? 800-845-0787 or
2014-2015 Forms (page 2 of 2)

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