Juliette Fund Request

Juliette Fund Request

Girls participating in Girl Scouts as Juliette’s earn Juliette Funds instead of Troop proceeds. These Juliette funds are managed by GSMW and not the individual girl or Juliette Mentor. A Juliette may use this Juliette Fund Request form to request funding for program materials, membership fees, camp registration, or program registration.
JULIETTE GIRL DETAILS
Girl Name *

First Name Last Name
Age *
# of Years in Girl Scouts *
Girl Scout Level *
Email *
example@example.com
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Product Program Participation
I participated in the last Cookie Program *

Yes No
If Yes: Total Boxes Sold
I participated in the Fall Nut & Magazines Program *

Yes No
If Yes: Total Amount ($) Sold
JULIETTE MENTOR DETAILS
Juliette Mentor *

First Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Requesting Juliette Funds for the following: *

Council Store Items Program / Camp Registration GSUSA Membership Renewal Reimbursement Request

Council Store Item(s) Request

Please list the items that you are requesting from the GSMW Store. If you aren't sure of the details required, please visit the GSMW Online Shop.

OPTIONAL: If you have more than 5 items, please upload a document listing the additional items using the same format listed above and please include them in the total cost below.

Browse Files

Cancel of
Total Cost for Council Store Items *
Shipping & Handling *
SEE SHIPPING RATE CHART AT RIGHT

Program / SU Event / Camp Registration Funding Request

If you will be attending a Council Sponsored Program, please include a completed Program Registration Form and upload it below.
Type of Program *

Council Sponsored Program Service Unit Event Summer Resident Camp
Program / SU Event / Camp Name *
Location *
Start Date *

Month Day Year
Date
Cost *
***Council Sponsored Programs Only***

Upload Registration Form

Cancel of
Service Unit or other Non-Council Sponsored program
If the program is with a Service Unit program or other non-Council group, please complete this section.
Check Amount
Payment Deadline

Month Day Year
Date
Check Payable To
Program group (not the requesting parent)
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

GSUSA Membership Renewal

If you are requesting to renew membership(s), please complete the section below.
I am requesting funds for membership for the following individuals. *

Juliette Girl Juliette Mentor
Membership Year *

Current Year Membership (Oct. 1 - Sept. 30) Next Membership Year (available in April)

Reimbursement Request
What was this purchase for? *

Community Service Project
Total Cost *
Receipt Upload

Browse Files
If you have trouble, please email your receipt to customercare@gsmw.org. Cancel of
Reimbursement Check

Please allow 4-6 weeks for your reimbursement check.
Check Written To *

First Name Last Name
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Reimbursement Request