Financial Assistance Application
Application for financial assistance for a registered Girl Scout from Ohio's Heartland Council.

Limited funds are available for registered Girl Scouts who require financial assistance for Girl Scout essentials or to participate in Girl Scout program activities. Incomplete applications cannot be considered.
1. Please use A SEPARATE application for EACH Girl Scout.
2. Fill out the ENTIRE Financial Assistance Application.
3. The leader’s name or Girl Scout adult contact (for individually registered members)
must be provided.
4. See full details on gsoh.org.

Girl Scout is requesting assistance for: *
Required
If you are requesting assistance for a Program or Camp, which one?
Your answer
Girl's first name *
Your answer
Girl's last name *
Your answer
Street Address: *
Include, City, State, Zip
Your answer
County: *
Your answer
Primary Phone: *
Your answer
Email: *
Your answer
Current Age Level: *
Please check your yearly family income range: *
Number of Children in Family *
18 and under
Your answer
Parent / Guardian Name:
Your answer
Parent / Guardian Name:
Your answer
Have you participated in both council product programs *
Required
If not, why?
Your answer
Service Unit
Your answer
Troop Number
Your answer
Leader's Name
Your answer
Leader's Phone
Your answer
Leader's Email
Your answer
Please state specific reasons why you are applying for financial assistance: *
Your answer
Total cost of essentials or program fee:
$
Your answer
Amount of assistance requested: *
$
Your answer
Submit
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