Council Program and Travel Financial Assistance Application

Council Program and Travel Financial Assistance Application
Girl Scouts of Southern Illinois is committed to offering programs to all girls, regardless of their ability to pay the full fee. Please consider the following requirements before completing the form. It is expected that the parent/guardian applying for assistance pay at least 50% of the fee. All requests are kept confidential.
- Girl for whom financial assistance is being requested must be a member of the Girl Scouts of Southern Illinois council
- Financial assistance application must be completed in its entirety prior to registering for a program
- Financial assistance is available for individuals only, not troops
- Financial assistance is available for programs which cost a minimum of $20
- Financial assistance form must be submitted separately for each girl and program
- The request will not be processed if the form is not completed in its entirety
- Applications will be processed and caregiver will be notified of decision by email. If approved, the caregiver will be emailed with instructions. Program registration will not be complete until the payment in full has been made
- Financial assistance is available while funding lasts
  
  For questions about this form or the process, please contact Customer Care at customercare@gsofsi.org or (800) 345-6858
Girl's Name

First NameLast Name
Girl's Date of Birth*

MonthDayYear
Date
Troop Number (enter "Juliette" if registered independently)*
Number of years in Girl Scouts*
Grade Level at time of program*

GS Daisy (Kindergarten-1st grade)GS Brownie (2nd-3rd grade)GS Junior (4th-5th grade)GS Cadette (6th-8th grade)GS Senior (9th-10th grade)GS Ambassador (11th-12th grade)
Caregiver Name*

First NameLast Name
Caregiver Email*
example@example.com
Caregiver Phone*
Please enter a valid phone number.
Caregiver Zip Code*

Street Address

Street Address Line 2

City

Zip Code
Program Attending*

1/10/25 Aquatic Cove Dreamland $802/1/25 - PAT Training $402/8/25 Icy-Wonderama Ice Skating $202/15/25 Galentine's Day Paint and Juice Sip DBJ $202/15/25 Galentine's Day Paint and Juice Sip in MTV- D-J $203/15/25 Zoo-tastic Slumber Safari $603/22/25 Cosmic Curiosity Night - Older Girls $254/5/25 CIT Training $404/6/25 PAT Training $404/12/25 Caving at Camp Wartburg $354/12/25 InventHER Day at Greenville University D-A $355/17/25 Zoo-tastic Slumber Safari $605/24/25 STEMtastic Learning Kit- Brownies Edition $306/11/25 Georgia Getaway: GSofSI Journey to Savannah, GA! $850.006/14/25 PAX London $35507/20/25 Niagara Navigators: GSofSI Adventure to Niagara Falls, NY! $950.00
Has this Girl Scout received financial assistance for a council program this membership year?*

YesNo
When was the previous assistance received?*
Household gross income over the last year (include all sources of income, such as child support, unemployment, disability, social security, public assistance, etc.)*
Household Size (number of individuals)*
Is this girl also applying for Girl Scout Experience Funds (GSEF) for this program?*

YesNo
If the registrant is also applying for Girl Scout Experience Fund, the application must be turned in before the registration deadline and before filling out this financial assistance request.
Please enter any further information to help us make a decision about financial assistance for this girl
Caregiver Signature: By signing below you are stating that the above information is accurate to the best of your knowledge*

Clear
Date Submitted

MonthDayYear
Date
Should be Empty: