How has this volunteer utilized key leadership qualities to increase the sphere of influence of the Girl Scout
movement?
Describe how this volunteer has made a difference and/or a lasting impression on our Girl Scout Council
during the last service year utilizing her/his time and talent:
Please list other pertinent details of this volunteer’s background that may support this nomination:
Individuals providing letters of endorsement (individuals who support this nomination and would
be familiar with this nominee’s contributions to GSWPA):
1. Name:
Address:
Position
Street
City
Phone-Day:
State
Zip
State
Zip
State
Zip
State
Zip
Email:
2. Name:
Address:
Position
Street
City
Phone-Day:
Email:
3. Name:
Address:
Position
Street
City
Phone-Day:
Email:
4. Name:
Address:
Position
Street
City
Phone-Day:
Email:
Name of person submitting nomination form:
Signature:
Date:
Address:
Phone:
Email:
130
Position: