Special Funding Financial Aid Application

Please fill out the form below to request aid through the Wellcare and special funding program.

If you have any questions, please email us or call 800.695.6690.

Are you currently in a troop? *
Race (check all that apply): *
Ethnicity: *
Do you have Wellcare Medicaid? *
Did a caseworker refer you? *
Applying For (check all that apply): *
Girl Scout Materials: *