Girl Scouts Of Minnesota And Wisconsin River Valleys Heart In Hand Pin (Service Unit) Nomination Application Form
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4HEART IN HAND PIN (SERVICE UNIT) NOMINATION APPLICATION
The Heart in Hand (service unit level) pin is a River Valleys award that recognizes outstanding service (other than that of a leader,
co-leader or assistant leader) that has benefited a Girl Scout troop or service unit. This award may be given to a Girl Scout
member, non-member or a community organization that has given a significant amount of time and energy to Girl Scouts. A
nomination application and one endorsement questionnaire is required. Nomination deadlines: Due March 15 for April events;
due April 15 for May events; due May 15 for June events. Recognition is a pin.
Award Requirements:
Individual, group or organization that has given meaningful and outstanding service.
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Candidate is skilled in their area of expertise.
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Girl Scout registration not required.
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Candidate has not received this award in the past three years.
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Service and/or project for which the nomination is being submitted is completed.
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Service met Safety-Wise criteria.
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Service is defined as time and talent. Monetary contributions do not qualify.
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Service must have been provided in a role other than leader, co-leader or assistant leader (for example, a troop cookie
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manager who went above and beyond the position description, a community organization that shared their time and
talent at encampment or a troop parent who shared a talent at a series of troop meetings).
Nomination Instructions:
Coordinate the completion of the required application and endorsement questionnaire. These can be submitted by the
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same person or by different people as long as the nominator/endorser is familiar with the candidate’s volunteer service.
Note that if the candidate is approved for an award, s/he will receive a copy of the endorsement questionnaire.
River Valleys’ provides a PDF endorsement questionnaire to make the process easier. Please visit
to
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find the appropriate endorsement questionnaire.
Submit completed nomination application with the required endorsement questionnaire. The due date is dependent on
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the date of the recognition event (see above). Instructions are on the back of this form.
Incomplete endorsement and/or application may result in disqualification of the nomination.
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Please do not use staples if submitting hard copies.
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Award frequently asked questions (FAQ), Award descriptions and endorsement letter questionnaires are available at
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This award will be distributed at a local event established by the service unit or at another venue as determined by the nominator
and/or award recipient.
Candidate Information:
Name: _________________________________________________________ Service Unit: ______________________________
Describe volunteer role relevant to nomination:______________________________________________________________
Complete address: _______________________________________________________________________________________
Phone: ____________________________ Email: ________________________________________________________________
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Service Center:
Brooklyn Center
Northfield
Redwood Falls
Rochester
St. Paul
Nominator Information:
Name: _________________________________________________________ Service Unit: ______________________________
Complete address: _______________________________________________________________________________________
Day Phone: ______________________________________ Alternative phone: _______________________________________
Email: ___________________________________________________________________________________________________
2014-2015 Forms (page 1 of 2)
HEART IN HAND PIN (SERVICE UNIT) NOMINATION APPLICATION
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