Girl Empowerment Series: Mentorship Application

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Be part of a unique mentoring experience in a camp setting. You’ll be matched with a mentor during the camp—our mentors are inspiring women from a variety of professional backgrounds. Enjoy challenging and fun adventures with your mentor such as the adventure course, swimming, archery, yoga, a special formal dinner, and more! Explore career planning and networking while developing a strong bond with the other girls and women at camp. Learn how to develop healthy relationships, become more confident, and gain a strong sense of self, too!

Please submit this application plus two letters of recommendation using this reference form. References may be from a teacher, community member, coach, or Girl Scout volunteer. A parent/caregiver signature is also required.

The application deadline is Wednesday, May 1, 2024.

If you have any questions, please email us or call 402.558.8189.

Applicant Information

Girl First Name: *

Girl Last Name: *

Date of Birth: * +

Parent/Caregiver First Name: *

Caregiver Last Name: *

Street Address: *

Apt. #:

City: *

State: *

ZIP Code: *

Phone: *

Email: *

Number Years as Girl Scout: *

School Name: *

Grade Fall 2024: *

Extracurricular Activities

Please share with us information regarding your volunteer, extracurricular, and/or community service activities. Type "n/a" if there are more fields than required.

Extracurriculars: * 🛈

	Activity	Grades Involved	Hours per Week	Positions/Honors
1	Activity	Grades Involved	Hours per Week	Positions/Honors
2	Activity	Grades Involved	Hours per Week	Positions/Honors
3	Activity	Grades Involved	Hours per Week	Positions/Honors
4	Activity	Grades Involved	Hours per Week	Positions/Honors

Reference Information

Please provide the names and information of the two adults you have asked to submit references for you. Consider someone from the Girl Scouts, a teacher, a sports coach, or a member of your place of worship.

Be sure to provide your references with the Girl Empowerment Series: Mentorship Reference Form.

Reference 1

First Name: *

Last Name: *

Phone Number: *

Email Address: *

Relationship to Applicant: *

Reference 2

First Name: *

Last Name: *

Phone Number: *

Email Address: *

Relationship to Applicant: *

Essay Questions

1. What drives you to be involved in school, community activities and/or Girl Scouts? How do you benefit? How do others benefit from your involvement? *

2. What are your educational and career goals? How will this experience help you in obtaining your goals? *

3. Answer ONE of the Following Questions:

Name one important experience in your life. How has it affected you and what have you learned?
Describe an experience where you had significant interaction with adults and the role you played in the experience.
How do you demonstrate your leadership skills on a daily basis?

Applicant Understanding

I have read the event description and am able, and plan to participate in Girl Empowerment Series: Mentorship if selected.

Sensitive Issues: During Girl Empowerment Series: Mentorship, the mentors, and other girl campers, frequently share personal information about their lives, career paths, challenges they have faced and their goals for the future. Participants must be mature enough to listen respectfully, be supportive and keep these conversations confidential.

Applicant Signature: * 🛈

clear

Parent/Caregiver Permission

I have read the Girl Empowerment Series: Mentorship description to which my daughter is applying. To the best of my knowledge, my daughter has a clear understanding of the event(s) she has applied for, and if selected, she has my permission to participate.

I grant Girl Scouts Spirit of Nebraska permission to share my daughter's email address with other Girl Scout participants. *

Parent/Caregiver Signature: * 🛈

clear