GSDAC Application

Girl Scout Leadership Application

Girl Member to Board of Directors

Girl Scout Delegate Advisory Council

Deadline for Application: November 30, 2023

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Home Phone*

Cell Phone*

County you live in*

School Attending:*

Grade in school as of September 2024 *

Date of Birth*

Years in Girl Scouting*

Email*

Have you received:

Gold Award Silver Award Bronze Award

Positions Applying For:

Girl Scout Member to The Board of Directors (GSDAC membership included) Girl Scout Delegative Advisory Council

Describe why you have an interest in serving in the above positions.

What experiences do you hope to gain?

How will the council benefit from your involvement in the above positions?

Please describe your involvement in Girl Scouting.

Please describe your community involvement.

Please list all extracurricular activities you participate in (sports, clubs, etc.)

Parent/Guardian Permission

I have read the position description for Girl Member at Large Delegate/Girl Scout Member of the Board of Directors. To the best of my knowledge, my daughter has a clear understanding of the position for which she is submitting the application, and if selected, she has my permission to participate.

I grant Girl Scouts of Ohio’s Heartland, Inc. permission to share her phone number, mailing address, and email address with other Girl Scout board members. I understand that travel is involved and it is my responsibility to ma ke sure my daughter is transported to all board/delegate related meetings.

Girl Member Name*

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

Date*

Parent/Guardian Signature

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