Financial Assistance for Membership Dues Form

This form is to be completed in combination with registration in order to be considered elgible for financial assistance towards membership dues. A paper copy of this form can be found here, and can be submitted to any Girl Scouts of Northern Illinois Resource Center. If you have questions about financial assistance, please contact Customer Care at customercare@girlscoutsni.org or at 844-GSNI-4-ME (844-476-4463).

Registrant Name(s)

Please include the name(s) of all members requesting financial assistance.

Parent Name

Phone Number

Email Address

Zip Code

Troop #

Oops

I marked financial assistance by mistake.

If selecting this option, there is no need to continue to fill out the rest of the form. You can also call in your membership dues payment ($25 per registrant) to 844-476-4463.

How many people are in your household?

How many people in your household will be participating in Girl Scouts this year?

Are there any extenuating circumstances in your household? If so, please describe below:

If you are renewing your membership, please select all that you have participated in during the previous membership year:

Girl Scout Fall Product Program

Girl Scout Cookie Program

Service project through Girl Scouts

I understand that not all requests may be granted. I verify that I am unable to fund membership dues without financial assistance.

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