Outstanding Leader Award Nomination Form

Nominee's Name: Phone:

Address: City: Zip:

Service Unit Number:

Racial/Ethnic Information:
A: American Indian or Alaska Native Asian Black or African American Hawaiian or Pacific Islander White Other

B. Hispanic or Latino Not Hispanic or Latino

The nominee is:

A: Troop Leader Assistant Leader for Troop Number

B: Daisies Brownies Juniors Girls 11-14 Girls 14-17

The nominee has served in this position for years (a minimum of one full Girl Scout membership year*).

The nominee completed Getting Started on at .

The nominee completed Program Age Level Basics on: .

Ranking: Please indicate the number (on a scale of 1 to 5) that most closely indicates the level of service given by the nominee. 1=hardly ever happens; 3=usually happens; 5=always happens without fail.

Every troop member has had opportunity for personal growth. 1 2 3 4 5

Adequate communication is maintained between families and troop. 1 2 3 4 5

The girls are involved in troop decisions. 1 2 3 4 5

The girls manage the troop money and budget. 1 2 3 4 5

The girls increased their knowledge of Girl Scout Program by earning Try-Its, Badges, Interest Projects, etc. 1 2 3 4 5

The troop retains current members and recruits new members. 1 2 3 4 5

The girls learned to appreciate and accept troop members' differences. 1 2 3 4 5

The nominee's service has exceeded the expectations for the position. 1 2 3 4 5

*The Girl Scout membership year runs from October 1 through September 30.

Example of Outstanding Service:

(Give an example of how the service of this nominee has benefited the girls in the troop.)

Submitted by: Email address:

Girl Scout Position:

Address: City, Zip:

Phone: (h) (o)
Date Submitted:

Forms are due February 25, 2010!