Uniform Financial Assistance Application

Uniform Financial Assistance Application
To be eligible for uniform assistance, girls must agree to participate in the council sponsored product sales, be a currently registered Girl Scout (membership assistance is available), and meet financial criteria that is listed below. You will be notified of approval or denial.
Girl Full Name

First NameLast Name
Girl Date of Birth

MonthDayYear
Date
Girl receives one of the following.

Other
Please provide the Member ID
School Attending
Girl Scout Level
Number of Years as a Girl Scout
Parent/Guardian Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of Adults Living in Home
Number of Children Living in Home
Financial Information

Income verification is requested to demonstrate financial need.
Household Income
Please explain and special circumstances and/or reasons for requesting uniform assistance.
Please upload income verification. Examples of accepted items are: Medical Card, EBT Card, Unemployment Paperwork, Public Housing, etc. We do NOT recommend paystubs.

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Uniform Pieces Request

Items included are the Daisy Tunic or Sash for Brownie-Ambassador. The American Flag Patch, Council Identification Set, and 4 Troop Numbers,

If a vest is desired, families are responsible for paying the difference of cost between sash and vest.
Uniform Piece Desired
If you ordered a Daisy Tunic, what size would you need:
If you ordered a sash, what size would you need:
If you ordered a vest, families are responsible for paying the difference between the sash or a vest (approx. $13-$16 depending on the level.) Please indicate below what size you would need.
What troop numbers are needed?
Has/will your girl be participating in the Fall Product or Cookie Program?
Today's Date

MonthDayYear
Date
By signing my name below, I am verifying that the above information is accurate to the best of my knowledge.
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Application Fee
A $5.00 application fee is required to submit a Financial Assistance request. This fee helps offset a portion of the administrative costs associated with reviewing and processing applications, allowing us to continue providing assistance to as many girls and volunteers as possible.

If the application fee presents a hardship, please contact us before submitting your application. Girl Scouts of Kentucky’s Wilderness Road is committed to ensuring that financial circumstances do not prevent participation in Girl Scouting.

$5.00 Quantity

Total

$0.00
Should be Empty:

Uniform Financial Assistance Application

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