ANNUAL MEETING 2016 DESIGN TEAM APPLICATION

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ANNUAL MEETING 2016

DESIGN TEAM APPLICATION

Completing this application is your first step towards a Girl Scout movement leadership

experience! Please read instructions carefully.

INSTRUCTIONS

1. This application consists of three parts:  The Application Form

 Essay (you must use separate sheets of paper)

 Reference Form (you must ask two people to provide a reference for you. They should send the reference directly to [email protected])

2. Type or print clearly using black ink. Complete the entire application and continue questions on a new page if your answers are longer than the space provided. Clearly label the extra pages with your name.

3. Please write your essays on separate pages.

4. Be sure to include your name on the top of each page of the application.

5. Make a photocopy of your entire application before sending it to the Council.

6. Make sure you and your parent/guardian signs the last page.

7. Mail, email or fax your completed application to Amanda Martin at [email protected], fax: 602.452.7036, 119 E. Coronado Rd., Phoenix, AZ 85004

8. All applications must be received by Friday, October 23, 2015.

APPLICANT INFORMATION

Name Level Troop #/IGM

Address City State Zip

Email Phone

Birthdate Current Grade in School # of Years in Girl Scouts

Check if you’ve earned: _{☐ Bronze Award} _{☐ Silver Award} _{☐ Gold Award}

Racial/Ethnic Breakdown – In order to monitor and promote the participation of girls from various racial and cultural backgrounds, we request that you provide the following information. You are not required to respond. The information

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ANNUAL MEETING 2016

DESIGN TEAM APPLICATION

PART 1: REFERENCES

Please PRINT/TYPE the names and information of the two adults you have asked to submit references for you. Consider someone from your Girl Scout Council, a teacher, sports coach, or a member of your place of worship. Be sure to give these adults the “Girl Scout–Arizona Cactus-Pine Council Annual Meeting Design Team 2016 – Reference Form.”

1

Name Relationship to You

Phone Email

2

Name Relationship to You

Phone Email

PART 2: YOUR INTERESTS

Please mark your top three interests with 1, 2, and 3.

Graphic Design Social Media

Entertainment / Performance (dance, music, etc) Writing

Public Speaking

Global Issues Inclusivity Event Logistics

Leading an Activity for Daisies, Brownies, Juniors

PART 3: ESSAY

Please attach a separate sheet of paper(s) to submit your essay. Girl Scouts is a global sisterhood and a girl-led social justice movement. In this spirit, Girl Scouts-Arizona Cactus-Pine Council hosts an annual meeting conceptualized, designed and implemented by a team of Senior and Ambassador level Girl Scouts. Please share what qualities, special skills and experience you can contribute as part of a team to ensure this year’s Annual Meeting is a success?

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ANNUAL MEETING 2016

DESIGN TEAM APPLICATION

PART 4: SIGNATURES

Applicant Understanding:

I have read the description of the Annual Meeting Design Team, including time commitments, and feel I am able to fully participate. If I am selected, I have a definite plan to accept participation and organize my schedule accordingly.

I give consent to be interviewed, photographed, videotaped, or electronically imaged for the purpose of promotional materials, news releases, or other published formats for Girl Scouts-Arizona Cactus-Pine Council (GSACPC). The images will be the property of GSACPC. I hereby release and hold harmless GSACPC from any claim arising from the use of these images.

I have confirmed that my contact information on the Application form is correct.

Applicant’s Signature Date

Parent/Guardian Permission:

I have read the description of the Annual Meeting Design Team, including time commitments. To the best of my knowledge, the applicant has a clear understanding of the commitment participation on the Design Team entails. If selected, she has my support and permission to participate.

Parent/Guardian Name

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ANNUAL MEETING DESIGN TEAM

REFERENCE FORM

PART 1: TO BE COMPLETED BY APPLICANT

Applicant’s Name

Thank you for providing this reference. Please complete this form and return it to Amanda Martin:  Email – [email protected]

 Fax – 602.452.7036

 Mail – 119 E. Coronado Road, Phoenix, AZ 85004

I am applying to the Girl Scouts–Arizona Cactus-Pine Council Annual Meeting Design Team. I have attached the description of the Design Team so that you can comment on my abilities and interests.

PART 2: TO BE COMPLETED BY PERSON GIVING THE REFERENCE

Your Name

How long have you known the applicant? Relationship to Applicant

Check one rating in each category to assess the following qualities of the applicant.

1 = Don’t Know 2 = Below Average 3 = Average 4 = Above Average 5 = Excellent

1 2 3 4 5

Is dependable and responsible

Is able to share ideas and feelings

Is able to work with both peers and adults

Has poise in meeting people

Accepts differences in people

Is able to contribute as a member of a team

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ANNUAL MEETING DESIGN TEAM

REFERENCE FORM

Applicant’s Name

Describe the applicant’s special strengths and/or skills that would enable her to succeed as a member of the Annual Meeting 2016 Design Team. Please give specific examples. If more space is needed, use additional sheets.

Printed Name

Signature Date

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ANNUAL MEETING DESIGN TEAM

REFERENCE FORM

PART 1: TO BE COMPLETED BY APPLICANT

Applicant’s Name

Thank you for providing this reference. Please complete this form and return it to Amanda Martin:  Email – [email protected]

 Fax – 602.452.7036

 Mail – 119 E. Coronado Road, Phoenix, AZ 85004

I am applying to the Girl Scouts–Arizona Cactus-Pine Council Annual Meeting Design Team. I have attached the description of the Design Team so that you can comment on my abilities and interests.

PART 2: TO BE COMPLETED BY PERSON GIVING THE REFERENCE

Your Name

How long have you known the applicant? Relationship to Applicant

Check one rating in each category to assess the following qualities of the applicant.

1 = Don’t Know 2 = Below Average 3 = Average 4 = Above Average 5 = Excellent

1 2 3 4 5

Is dependable and responsible

Is able to share ideas and feelings

Is able to work with both peers and adults

Has poise in meeting people

Accepts differences in people

Is able to contribute as a member of a team

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ANNUAL MEETING DESIGN TEAM

REFERENCE FORM

Applicant’s Name

Describe the applicant’s special strengths and/or skills that would enable her to succeed as a member of the Annual Meeting 2016 Design Team. Please give specific examples. If more space is needed, use additional sheets.

Printed Name

Signature Date