Membership Financial Aid Application

Girl Scouts Spirit of Nebraska is committed to providing all girls and adults the opportunity to participate in the Girl Scout Leadership Experience.

Please complete one form per household. You may apply for up to four girls and two parents/guardians per application. This application will automatically omit sections that do not apply to you.

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

Section 1: Household Information

Who Are You Applying For?
NOTE: Adults may only apply for financial aid if they are a troop co-leader, reside in Rock County, NE, or have a WellCare/Healthy Blue Medicaid Health Plan. *
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Section 2: Girl Information

(Not Applicable)

Girl Applicant 1

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1. Did she participate in the most recent Girl Scout Cookie or Fall Product Program? *
2. Requesting Aid For: *
2a. Membership Materials: *

Girl Applicant 2

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1. Did she participate in the most recent Girl Scout Cookie or Fall Product Program? *
2. Requesting Aid For: *
2a. Membership Materials: *

Girl Applicant 3

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1. Did she participate in the most recent Girl Scout Cookie or Fall Product Program? *
2. Requesting Aid For: *
2a. Membership Materials: *

Girl Applicant 4

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1. Did she participate in the most recent Girl Scout Cookie or Fall Product Program? *
2. Requesting Aid For: *
2a. Membership Materials: *

Section 3: Parent/Guardian Information

(Not Applicable)

Caregiver Applicant 1

Is this parent/guardian also a troop co-leader? *
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Caregiver Applicant 2

Is this parent/guardian also a troop co-leader? *
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Section 4: Qualifying Financial Information

Adults not registered as troop co-leaders will receive financial aid for membership ONLY if they have a WellCare/Healthy Blue Medicaid Health Plan or live in Rock County, Nebraska.

1. Do you live in Rock County, NE? *
2. Do you have a WellCare/Healthy Blue Medicaid health plan? *
0/100 characters
4. Did a caseworker refer you? *
0/500 characters

Section 5: Signature

I certify that all of the information on this application is true and complete.

Signature: *
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