GSCCVA Gold Award

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Applications are accepted year-round.
Gold Awards are reviewed after October 1 & March 1 of each year.

Personal Information

Today's Date:

Name:

Address:

City:

State:

Zip:

Date of Birth:

Phone:

Your E-Mail:

Age:

Grade:

School:

Year Graduate High School:

Troop/Group Number:

or Juliette

# of Years in Girl Scouts:

Troop/Group Advisor:

Troop/Group Advisor's Phone:

Troop/Group Advisor's Email:

Gold Scout Award Project Advisor:

Project Advisor's Phone:

Project Advisor's Email:

Mother/Guardian:

Father/Guardian:

Family Email:

Hometown Newspaper:

Major Girl Scout Recognitions/Achievements/Service Projects:

	Bronze Award		Silver Award
	Senior Program Aide		Religious Awards
	Senior Girl Scout Community Service Bar		Ten year pin
	CIT I		CIT II
	Community Service Bar for Contributions to Girl Scouting
	Other

Gold Award Ceremony Intent (Choose one)

	I plan to receive my Gold Award at the "Walk of Fame" Council Recognition Event in the spring.
	I plan to receive my Gold Award at a Ceremony in my community on
	I plan to be recognized at the "Walk of Fame" Council Recognition Event in the spring and receive my Gold Award at a Ceremony in my community on .

Gold Award Photo

I will send a 5" x 7" photo and two 3 1/2" x 5" photos in my Girl Scout uniform by March 1. I will also submit three project photos to be used in a multimedia presentation by March 1.

Other Major Activities/Awards - School, Church, Community, Clubs

How has Girl Scouting influenced your life?

What are your plans after graduation? (work, career plans, what college, what major, etc.)

Tracking Project Hours

Title of Project:

Date Started:

Date Completed:

Total Number of Hours:

Reflection and Evaluation

Briefly summarize your project. Include the issue your project addressed and the methods you used for meeting the project objectives.

Discuss the benefits your project provided to others in the community.

Detail the method used for evaluating the impact of your project.

What did you learn about yourself as a result of this project?

What aspects of your project would you change or do differently?

What was the most successful aspect of your project?

How did you finance your project? Submit an actual budget of income and expenses.

My project involved participants with helpers.
It was an individual or group project. (If group project, list names of other Girl Scouts earning their Gold Award who worked with you.)

Would you like to acknowledge anyone who helped you fund or complete your project? If so, please name:

Signature and Confirmation

I have completed my Gold Award with a minimum of 65 hours in planning and carrying out the project. Yes No

Please retype your name for your signature: Date:

Please retype Parent/Guardian name for signature: Date:

Email Confirmation: A copy of this report will be emailed to your project advisor for approval and to you to retain for your records. A signature is not required for electronic forms. Please enter your email address and the email address of your project advisor:

Your Email Address:

Project Advisor's Email Address:

Family Email Address: