(Required fields have a "*".)

Last Name *

First Name *

Middle Name

Maiden or Previous Name

Street Address *

A value is required.

Town *

A value is required.

State *

Select one New Hampshire Vermont  Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Massachusetts Maryland Michigan Minnesota Mississippi Montana Missouri Nebraska Nevada New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia  Washington  Washington, DC West Virginia  Wisconsin  Wyoming  Please select an item.A value is required.

Zip Code *

A value is required.

Phone *

A value is required.

E-mail *

A value is required.

Have you lived or worked in the state of Massachusetts within the last 5 years? * No Yes Please select an item.

Interest Indicators

Have you ever been a registered member of Girl Scouts?

Yes No If yes, number of years as a girl:    numbers of years an adult:

What volunteer position are you applying for?(if known)

Troop number you would like to volunteer with (if known):

In which community or area would you like to volunteer?

I would like to work with:(Check all that apply.)

Girls      Adults

I would like to work with girls in this Pathway:
(Check all that apply.)

I would like to work with adults in:
(Check all that apply.)

Special skills or talents you wish to share:

Employment or Volunteer Experience
Please provide information for your most recent employment or volunteer position.

Organization/Company Name

Complete Mailing Address

Dates: From     To    Reason for Leaving

Position    Select one Employed Volunteer

Responsibilities

Supervisor's Name    Telephone

References *
List three persons who are not relatives who have agreed to serve as a reference, and who can speak to your qualifications to be a Girl Scout volunteer. If you have previous volunteer experience in another organization, one of the references should be from that organization. If you have previously worked with children and your volunteer position is relevant, one of your references should relate to that particular experience. Please provide a complete mailing address or email address for each reference, or your application processing may be delayed. If your reference does not have an email address please enter NA in the email field.

Please notify the people you have listed as references so they will be aware that we will be contacting them.

Name * A value is required.  Relationship * A value is required.

Complete Mailing Address * A value is required.

Telephone * A value is required.   Email * A value is required.

Name * A value is required.  Relationship * A value is required.

Complete Mailing Address * A value is required.

Telephone * A value is required.   Email * A value is required.

Name * A value is required.  Relationship * A value is required.

Complete Mailing Address * A value is required.

Telephone * A value is required.   Email * A value is required.

This is an application for a volunteer service position with Girl Scouts of the Green and White Mountains for which there is no monetary compensation.

There will be no discrimination against an otherwise qualified adult volunteer by reason of disability or on the basis of age. Furthermore, there will be no discrimination on the basis of race, color, ethnicity, sex, creed, national origin, or socioeconomic status.

I understand that any misrepresentation, omission, or falsification of any fact on this application or during any interview will be cause for rejection of this application or dismissal from volunteer services.

Electronic Signature Authorization:

Signature: A value is required. * Click checkbox to sign electronically, then enter your full name.

Date:

Additional Comments:

    
You will be contacted by a Green and White Mountains staff member or a volunteer from your town. If you have not been contacted within two weeks, please call 888.474.9686.