VOLUNTEER APPLICATION
(Council Use Only) □ New Applicant □ Updating Clearances
Date_________________
Instructions: Please complete and return to: GSWPA, 5681 Route 6N, Edinboro, PA 16412
Name
Address
Street
City
Phone: (H)
State
(C)
Zip Code
Email
School District_____________________ School Name_____________________ Troop #__________
(if applicable)
HOW DID YOU HEAR ABOUT VOLUNTEER OPPORTUNITIES?
Volunteer Match
Twitter
Recruitment/Info session Word of mouth
Facebook
School flyer
Alumnae newsletter
Radio/TV ad
Volunteer Fair
Other
(location)
WHAT TYPE(S) OF VOLUNTEER WORK ARE YOU INTERESTED IN?
With Children With Adults Both
Grade level Daisy (K-1)
Grade level Brownie (2-3)
Grade level Junior (4-5)
Grade level Cadette (6-8)
Grade level Senior (9-10)
Grade level Ambassador (11-12)
Pathway
Troop
Camp
Series
Troop Leader Assistant Gold Award Committee
Chaperone Events
Adult Award Committee
Transportation/Driver
Trainer/Facilitator
Teach Hobby/Skill
Outdoor Activities
Other
Event
Troop Committee Member
Treasurer Cookie chairperson
Service Unit Team Member
Service unit finance manager
Product sales manager
Program Opportunities
Urban Girl Scouting
Program Team/Council events
Travel Trip Advisor
Other
Travel
http://www.gswpa.org/girls/pathways/
(See pathway link)
Fall product chairperson
Organizer/Recruiter
Coach/Consultant
Day Camp___________
Location_____________
Core Camp
Other
Service unit registrar
Service unit manager
Camp Property Team
Camp Program Team
CRIMINAL BACKGROUND
Note: A conviction record will not necessarily be cause for disqualification.
Have you ever been convicted of a crime? Yes No
If yes, please state offense, date and location:
I certify that all information provided on this application is true and complete. I understand that falsification or significant omissions of any
information may be considered justification for dismissal if discovered at a later date. I accept the Girl Scout Promise and Law and the purpose
of Girl Scouting and promise to uphold and interpret them to the best of my ability. I understand that I will have to successfully pass the required background checks. Adult volunteers are selected based on the information provided and on their ability to perform the duties of the position description. There shall be no discrimination on the basis of race, color, ethnicity, sex, creed, national origin, socio-economic status, age or
disability. (Girl Scouts of the U.S.A . Blue Book of Basic Documents)
Date
SIGNATURE
6/14
109