girl scout rolinnorth ca a coastal pines · girl scout silver award final report, continued . b....
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PG103/1-11
Girl Scout – North Carolina Coastal Pines
Submit the original completed form to your council. Make copies for your Girl Scout Silver Award project
advisor and you to keep.
Contact Information
Name:
County: ________________Address:
City: State: Zip code:
E-mail: Phone:
Age: Grade: Year 8th Grade Completed:______ School: ________________________
Troop/Group Number: Troop/Group Volunteer:
Troop/Group Volunteer’s Phone: ( ) E-mail:
Girl Scout Silver Award Project Advisor:
Project Advisor’s Organization:
Project Advisor’s Phone: ( ) E-mail:
Your Team: List the names of individuals and organizations that worked with you on your Take Action
Project.
Team members Affiliation Role
Take Action Project
Project Title: Start Date: Completion Date: Hours:
A. Describe the issue your project addressed, what you achieved, and who benefitted.
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Girl Scout Silver Award Final Report, continued
B. Discuss the reasons for selecting this project.
C. How will your project be sustained beyond your involvement?
D. Explain the local and/or global link to your project.
E. Describe what you learned from this project. What did you learn about yourself as a result of this
project?
F. What was the most successful aspect of your project?
G. What aspects of your project would you change or do differently if you could start over?
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Girl Scout Silver Final Report, continued
Possible Future Impact
How do you think your leadership skills will grow in the future because of this project?
Your Signature: Date: ______
Project Advisor’s Signature: Date: ______
Actions Date
Received by Council
Final Approval Given
Approved: Date: ______
Council Representative
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Both pages of the form must be completed and submitted with the final report
Please complete the form below in its entirety along with emailing two digital photos (300 dpi) to [email protected]. Please include a photo of yourself (head shot) and, if applicable, a photo of the event or service project.
Name First Middle Last
Street Address
City ________________ Zip County _______ Home Phone ( )
School Name Grade School year
City Zip High School Graduation Year
Girl Scout member since (year) Troop # -or- Individually Registered
If you would like notice of your Girl Scout Silver or Gold Award sent to your school for your student file, to whom should it be sent?
Name Position E-mail
Briefly describe your Girl Scout Silver or Gold Award Project
Release for Minors
For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I hereby consent and agree to the following:
1. I hereby grant to Girl Scouts – North Carolina Coastal Pines (“GS-NCCP”), and others working for GS-NCCP oron its behalf, and each of its respective licensees, successors and assigns (each a “Releasee”), the irrevocable, royalty-free, perpetual, unlimited right and permission to use, distribute, publish, exhibit, digitize, broadcast, display, modify, create derivative works of, reproduce or otherwise exploit my name, picture, likeness and voice (including any video footage of the same) (collectively, “Media”), or to refrain from so doing, anywhere in the world, by any persons or entities deemed appropriate by GS-NCCP, for any purpose (except defamatory) including, without limitation, any use for educational, advertising, non-commercial or commercial purposes in any manner or media whatsoever (whether known or hereafter devised) including, without limitation, on the Internet, in print campaigns, in-store and via television. I agree that I have no interest or ownership in any of the Media.
Girl Scouts – North Carolina Coastal Pines 6901 Pinecrest Road, Raleigh, NC 27613
1-919-782-3021 or 1-800-284-4475
PG127/8/14
2. I shall have no right of approval, no claim to compensation and no claim (including, without limitation,
claims based upon invasion of privacy, defamation or right of publicity) arising out of any use, alteration,
blurring, illusionary effect or use in any composite form of my name, picture, likeness and voice. I agree that
nothing in this Release will create any obligation on GS-NCCP to make any use of the Media or the rights
granted in this Release. I hereby release and hold harmless Releasees from any claim for injury, compensation
or negligence resulting or arising from any activities authorized by this Release and any use of the Media by
GS-NCCP.
I give permission for my daughter’s information to be published in Girl Scout publications and in local media outlets. (i.e. newspapers, schools, places of worship, etc.)
I DO NOT wish for my daughter’s information to be published.
Date Girl Scout’s Signature
Parent or Guardian Signature
News media often want parents/guardians to be identified as the "daughter of" named persons. Correct forms include "Mr. and Mrs. John E. Smith," "Jane and John Smith," or the name of one or the other parent or a guardian. Please give your preference below.
________________________________________________________________________________
List the name(s) of local publications you’d like Girl Scouts – NC Coastal Pines to consider contacting: ____________________________________________________________________________ ____________________________________________________________________________
Girl Scouts celebrates the diverse set of topics girls explore as part of their Girl Scout Silver or Gold Award Take Action projects. As some topics can be considered sensitive in nature, GS-NCCP requests acknowledgement from a parent or guardian approving the topic.
I acknowledge and approve of the topic my daughter addressed through completion of her Girl Scout Silver or Gold Award project.
Parent or Guardian Signature
Document Retention
Girl Scouts – NC Coastal Pines retains electronic files of each Girl Scout Silver/Gold Award submission. The Council does not retain physical records submitted as a hard copy. Prior to submitting hard copy forms, please retain a copy for your records. Please select from the following only if hard copy documents are submitted:
I, ________________________________________(First and last name) understand that only an digital copy of my Girl Scout Silver/Gold final report will be retained by Council and that hard copy documents submitted will not be retained more than 60 days.
I, _________________________________________(First and last name) request the opportunity to pick up the hard copy of my Girl Scout Silver/Gold final report from the Council headquarters in Raleigh within 30 days of being notified that my award has been earned.
The preferred method for submitting completed documents is via email to [email protected].
PG104A/9‐10
Girl Scouts – North Carolina Coastal Pines
Girl Scout Silver/Gold Award Project Hours Log Record all activities you do as you work on your Girl Scout Award Project. Log each activity as you execute
them. You must submit this log with your Girl Scout Silver/Gold Award Final Report.
Date Start Time
Activities End Time
Hours/mins
Total Hours this page
PG104A/9‐10
Girl Scout Silver/Gold Award Project Hours Log – page 2
Date Start Time
Activities End Time
Hours/mins
Total hours this page
Total hours for Girl Scout Silver/Gold Award Project
Girl Scouts – North Carolina Coastal Pines
Girl Scout Silver/Gold Award ProjectBUDGET PLANNING WORKSHEET
Projected Expenses ‐ Use another sheet of paper for detailed lists of each grouping.
Site cost $
Fees (rentals, custodians, etc.) $
Permits (building, plumbing, etc.) $
Supplies (program supplies, first aid supplies, cleaning supplies, etc.) $
Printing $
Postage $
Food/beverage $
Thank you tokens (Project Mentor, Troop Advisor, etc.) $
Other $
TOTAL ESTIMATED EVENT EXPENSES $
Donations Of the items listed in the Projected Expenses section, list the ones that you may be able to get donated and by whom.Example: Possible donation of: construction paper By: Papers, Inc. Who to Contact: Manager Possible Donation of: By: Who to Contact:
Income Brainstorm and write down ideas for money‐earning projects.
Use the reverse for additional notes.
Girl Scouts – North Carolina Coastal Pines
Girl Scout Silver/Gold Award Project
Record of Income and Expenses
Girl’s Name
Project Title Record all income and expenses of your Gold Award Project here. Keep receipts and deposit slips in a safe place.
Date Paid to / Received From For
Amount Account
Expenses Income Balance
Girl Scout Silver/Gold Award Project Record of Income and Expenses (continued)
Date Paid to / Received From For
Amount Account
Expenses Income Balance
Make copies as needed
PG134/1-11
Girl Scouts – North Carolina Coastal Pines
GIRL SCOUT SILVER/GOLD AWARD IN-KIND DONATION FORM Date of donation: Donation description: Approximate In‐Kind Donation Value: $ Donated for Girl Scout Award Project: Silver Gold Company, organization, or individual making donation: Contact Name at company/organization: Address: City: State: Zip: Phone ( ) Donation solicited by: Address: City: State: Zip: Phone ( ) Anyone else involved in solicitation: Form submitted by: Date submitted: Has a “thank you” been made? Yes No If yes, what type of thank you? Card Letter Verbal By whom: Date made:
After completing the information above, mail with Girl Scout Silver/Gold Award Application:
Girl Scouts – North Carolina Coastal Pines Attn: Girl Scout Silver/Gold Award
6901 Pinecrest Road Raleigh, NC 27613
Or email to: [email protected]