Community Recognitions Application
Deadline February 15th
Name of Service Unit Representative Completing this Form
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Name of Business, Organization, or House of Faith
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Please describe why you feel this company, house of faith, or organization deserves this recognition:
To your knowledge, have they ever received Girl Scout recognition before?
No
Yes
If yes, when?
Which recognition are you applying for?
Plaque
Certificate
Service Unit Manager Signature
Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: