Girl Scouts Of Suffolk County Service Unit Coordinator Application Form Page 2

*What are your goals for recruiting new and/or retaining current SU Team members?

1. _________________________________________________________________________________________________________

2. _________________________________________________________________________________________________________

3. _________________________________________________________________________________________________________

*Are you satisfied with the current methods of communicating with your SU members? ! Yes

!

No

If no, how would you revise that method?

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

*What are your plans for encouraging increased participation in all Council-sponsored product sales campaigns?

1. _________________________________________________________________________________________________________

2. _________________________________________________________________________________________________________

3. _________________________________________________________________________________________________________

*Are you satisfied with the SU events and activities, including troop participation, that are held for your members? ! Yes

!

No

If no, what are your plans for offering new or revised events and how would you increase participation?

1. _________________________________________________________________________________________________________

2. _________________________________________________________________________________________________________

3. _________________________________________________________________________________________________________

*References (List at least 2 non-family members who are familiar with your qualifications).

NAME

ADDRESS

TOWN

ZIP

PHONE

EMAIL

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

*

I hereby authorize you to check all my educational references and the personal and employment references listed. I further authorize

these references to release to you all information known to them.

*

Do you know of any reason why you would not be able to perform the essential functions of the position for which you are applying

with or without reasonable accommodation? ! Yes

!

No

*

If you checked yes, please explain.______________________________________________________________________________

___________________________________________________________________________________________________________

*

Have you ever been convicted of a crime other than traffic violations? ! Yes

!

No

*

Are you a registered sex offender? ! Yes

!

No

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*

*

Signature______________________________________________________________

   

Date: ___________________

Please return to: Girl Scouts of Suffolk County, Attn: Jackie Morgan, Director of Membership, 442 Moreland Rd. Commack, NY 11725

Questions?     P lease   c ontact   K arin   J ensen-­‐Mirabile   a t  

k

jensen@gssc.us     o r   6 31.543.6622   x 221