Girl Scouts of Wisconsin Southeast FA Request

Tell Us About Your Family
Guardian First & Last Name*

First NameLast Name
Family Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of Girl Scout Members in your Household:*
Is your family enrolled in the "Wisconsin Shares Child Care Subsidy Program?”*

YesNoI Choose Not to Share
Please provide a brief explanation of why your family is requesting Financial Aid for membership, event or camp session.*

You will receive an email from customercare@gswise.org when your financial assistance has been reviewed. This email will provide you with more details.
By typing my name and checking this box, I confirm that all the information I have provided in this form is truthful and accurate.*

Agree
Parent/Guardian Virtual Signature*

Clear
Today's Date*

MonthDayYear
Date
Should be Empty:

Tell Us About Your Family