Juliette Funds Request Form

Juliette Girl Scouts (individually registered girls) should use this form to request funds. Requests are reviewed on a rolling basis by the Programs and Events Manager. Juliette funds are for girl use only. Funds can take 2 to 3 weeks to process, so requests should be submitted as far in advance as possible. Funds may not be requested for adult volunteers (e.g. outdoor education) or items unrelated to Girl Scouting. Please submit one (1) form per Juliette.

By submitting this form, you are stating that you are requesting funds on behalf of a current Juliette-registered Girl Scout with Girl Scouts of Southern Appalachians.

Girl Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Caregiver Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Caregiver Email*

example@example.com

Did the Juliette participate in the most recent cookie program?*

Has the Juliette participated in past cookie programs?*

Please list the years, the Juliette participated in the cookie program*

Did the Juliette participate in the most recent Fall Product program?*

Has the Juliette participated in past Fall Product programs?*

Please list the years, the Juliette participated in the Fall Product program*

Juliette funds for purchases, events, award projects and travel can cover up to $300 or up to 30% of the total amount, whichever is less.

Membership (annual membership dues and council service fee)GSCSA shop purchase (only for official Girl Scout uniform pieces, patches, badges, award pins, and materials directly related to Girl Scout programming)GSCSA staff-led eventGSCSA service unit eventProgram Partner event (reimbursement only - must attach receipt)Leadership Award or High Award project (reimbursement only - must attach receipt)GSCSA or GSUSA-sponsored travelLifetime Membership (suggested for graduating high school seniors)

Please list shop items*

Event Details*

Service Unit Event Details*

Are you requesting reimbursement? (Reimbursement is available only for items listed above. Receipts must be within the last 90 days and attached below. No payments will be given without proper documentation.)*

To whom should we make out the reimbursement check to?*

Please attach receipts or supporting documents*

By signing below, you attest that the information provided is complete and accurate to the best of your knowledge and that funds will only be used for the registered Juliette Girl Scout member.

Caregiver signature*

DateTime

Please direct any questions to info@girlscoutcsa.org