Girl Program 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 (GSLE).

NOTES:

  • Financial Aid may be requested for up to 50% of council-sponsored program fees for girls only, not for adult or sibling fees.
  • Please complete one form per girl. You may apply for up to two programs per application.
  • Girls must be registered Girl Scout members to attend council-sponsored programs. Please click here to request financial aid for membership.

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

Section 1: Applicant Information

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Section 2: Qualifying Financial Information

1. Do you live in Rock County, Nebraska? *
2. Do you have a WellCare/Healthy Blue Medicaid Health Plan? *
4. Did a caseworker refer you? *
5. Did your Girl Scout participate in the most recent Girl Scout Cookie or Fall Product Program? *
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Number In Household: *
 Total
Adults:
Dependents:
Girl Scouts:

Section 3: Program Fee Request

Requesting Aid For This Number of Programs: *
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Section 4: Signature

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

Applicant Signature: *
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