Financial Assistance For Council Sponsored Trips Form printable pdf download

Financial Assistance

for GSSI Council-Sponsored Trips

Financial Assistance provides financial help to girls who could not otherwise attend GSSI council sponsored

trips due to financial reasons. The amount of financial assistance will vary depending on the price of the trip

and financial needs of the family. Financial Assistance may generally cover 10-30% of the cost of the trip

minus the deposit. Once your application is processed, you will be notified if your application is approved and

the amount you will receive. All applications are kept confidential.

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Financial assistance is available for registered Girl Scouts who have registered for a GSSI Council

Sponsored Trip (this is for girls only).



Girls applying for Financial Assistance must participate in both Product Sale Programs (Fall Product Sale

Program and the Cookie Sale Program)



Financial assistance request will not be processed if not completed in its entirety.



If awarded, Financial Assistance will be applied to the last payment.



This form must be turned in with your registration form.

Name of girl: _________________________________________________________________________________

Address: ____________________________________________ City: ____________________ Zip: __________

Phone Number: _________________________ E-mail: ______________________________________________

Grade Level: ___________________Troop #: ______________________ Service Unit: ____________________

Destination attending: _______________________________________________ Cost$____________________

Father’s Name: __________________________ Place of Employment: _________________________________

Mother’s Name: __________________________ Place of Employment: ________________________________

Please list your family’s annual income for the last 12 months from all sources (earned, Social Security, child support, welfare,

unemployment compensation, etc.):

Annual Income: $_________________________

Number of person in household: ___________ (Needed to determine eligibility)

Do parents/family qualify for: _____ free lunch _____Reduced lunch

______food stamps _____unemployment

_____Medical Card

_____other

If there any other special reasons that you are applying for Financial Assistance, please attach a note or write on the back.

The above information is accurate to the best of my knowledge.

Signature of Parent/Guardian_______________________________________________ Date: ___________________

FOR OFFICE USE ONLY

Date Received: _____________________

Amount Approved: __________________

Date: ___________ Initials:___________

Account # _________________________

Confirmation sent: ___________________

Financial Assistance For Council Sponsored Trips Form