Training Scholarship/Financial Assistance Request Form

Girl Scouts, Hornets’ Nest Council7007 Idlewild Road • Charlotte, NC 28212704-731-6500, Outside Mecklenburg 800-868-0528Website: www.hngirlscouts.orgAdult Learning Opportunity Scholarship/Financial AssistanceRequest FormGirl Scouts, Hornets’ Nest Council provides financial assistance, on a need basis, for registered adults who wish toparticipate in adult learning opportunities. Complete and mail to the attention of the Director of Adult Development.Name:Address:City: State: Zip Code:Day Phone: ( ) Evening Phone: ( )Email: Troop # Service Unit/County:General Financial Assistance Request (see below for First Aid & CPR Reimbursement)I am requesting financial assistance for the following:Course Name: Course Date: Amount: $Course Name: Course Date: Amount: $Please explain why you are requesting financial assistance:Total Amount Requested: $Please note that financial assistance for events, such as Sky or Potpourri, will not cover extra items such as SkyWear or the optional lunch at Potpourri.First Aid and CPR Financial Assistance Request (see reverse for guidelines)I am acting as the First Aider for troop #(only one reimbursement per troop per year).Attach a copy of the agency cards, certificate or receipt.First Aid Fee $CPR Fee $Total Fees $Total Requested $Reimbursement for First Aid/CPR is up to ½ the course fee, not to exceed $30.00.AD-14 7/2/09