Uniform and/or Dues Assistance for Youth Members
Use this form to request assistance in purchasing a uniform, uniform components, program resources, and/or help towards paying troop dues. You must submit one form per each member you are requesting for. Submit six (6) weeks in advance of need as requests may take up to 6 weeks for review and processing.
**All store requests are only valid at Girl Scout of Connecticut Shops**
If approved, the shop you indicate at the end of this document will notify you when available for pick up Shipping at your own additional cost
Check out this website for an Essentials Guide to your youths uniform!
https://www.flipsnack.com/95EB8A5569B/2023-essentials-guide/full-view.html
Youth Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grade
*
Please Select
K
1
2
3
4
5
6
7
8
9
10
11
12
Date of Birth
*
-
Month
-
Day
Year
Date
Is your youth in a Troop or a Juliette (Independent Girl Scout, not in a Troop)?
Troop
Juliette
FOR STAFF ONLY: Grant if to be applied
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Troop Number
Would you like the Juliette Patch inplace of Troop Numbers?
Yes
No
Looking for a troop: Provide email or phone number below for our Customer Care team to best contact you:
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Family Information
Parent/Guardian #1 Name
*
First Name
Last Name
Parent/Guardian #1 Email
*
example@example.com
Parent/Guardian #1 Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian #1 Employer
*
Parent/Guardian #1 Occupation
*
Parent/Guardian #2 Name
First Name
Last Name
Parent/Guardian #2 Email
example@example.com
Parent/Guardian #2 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian #2 Employer
Parent/Guardian #2 Occupation
# of children (under 18) in household
*
Age(s) of children in years (please separate with comma)
*
# of other dependents in household
*
Do you receive any of the following (select all that apply)
*
AFDC
SSI
Social Security
Housing Subsidy
Subsidized Meals
None of the above
Other
Gross Family Income (select one)
*
$0-$24,999
$25,000-$34,999
$35,000-$44,999
$45,000-$54,999
$55,000-$64,999
$65,000-$74,999
$75,000 & above
From the list below, select all the expenses which affect your financial needs (checkmark all that apply)
*
Medical/Dental
Legal
Education
Debt
Single Income
Job Loss
Disability
Other
Please explain any unusual situations or expenses that should be taken under consideration.
*
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Troop Dues Request
Max allowance for troops to collect per youth member is $25 per year. Awarded troop dues will be deposited directly into the troop bank account.
Are you requesting funds to cover Troop Dues?
*
Yes
No
Troop Dues ($ amount per youth member per year)
*
$25 MAX allowance for troops to collect per youth member
Total amount of Troop Dues family can pay
*
$25 MAX allowance for troops to collect per youth member
Auto-calculated: Total amount requested for Troop Dues Assistance
This field will auto-calculate a total.
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Uniform Component & Program Resource Request
What level do you need components for?
Please Select
Daisy (K & 1st grade)
Brownie (2nd & 3rd grade)
Junior (4th & 5th grade)
Cadette/Senior/Ambassador (6th grade & above)
None
Daisy Uniform
Vest
Tunic
Not Needed
Daisy Uniform Pieces
Wavy Flag
Council ID Set
Troop Numerals (set of 5)
Daisy Petals
Insignia Tab
Daisy Membership Pin
WAGGGS (World Associations) Pin
Brownie Uniform
Vest
Sash
Not Needed
Brownie Uniform Pieces
Wavy Flag
Council ID Set
Troop Numerals (set of 5)
Insignia Tab
Brownie Membership Pin
WAGGGS (World Associations) Pin
Junior Uniform
Vest
Sash
Not Needed
Junior Uniform Pieces
Wavy Flag
Council ID Set
Troop Numerals (set of 5)
Insignia Tab
Trefoil Membership Pin
WAGGGS (World Associations) Pin
Cadette, Senior, Ambassador Uniform (Cargo Vest and Pocket Sash not included)
Standard Vest
Standard Sash
Not Needed
Cadette, Senior, Ambassador Uniform Pieces
Wavy Flag
Council ID Set
Troop Numerals (set of 5)
Insignia Tab
Trefoil Membership Pin
WAGGGS (World Associations) Pin
What shop will you pick up your items: (Please note all shops are closed on Fridays in July & August, the Lebanon Shop is closed Thursdays during Summer Camp. Check our website and social posts for up to date hours/sudden shop closures.)
*
Camp Merriwood: 650 Gardener St, Manchester, CT * Tuesday: 9:00 a.m.-5:00 p.m. Wednesday: 9:00 a.m.-5:00 p.m Thursday: 9:00 a.m. - 5:00 p.m. Friday: 9:00 a.m.-5:00 p.m.**Shop is closed from 1:30 p.m. - 2:00 p.m. for lunch** *Phone: (800)922-2770 x3240 *Email: hfshop@gsofct.org
North Haven Shop: 20 Washington Ave, North Haven, CT * Tuesday: 9:00 a.m.-5:00 p.m. Wednesday: 9:00 a.m. - 5:00 p.m. Thursday: 11:00 a.m.-7:00 p.m. Friday: 9:00 a.m. - 5:00 p.m. Saturday: 10:00 a.m. - 3:00 p.m. **Shop is closed from 2:00 p.m. - 2:30 p.m. weekdays for lunch** *Phone: (800)922-2770 x3330 *Email: shop@gsofct.org
Lebanon Shop: 175 Clubhouse Rd Lebanon, CT * Thursday: 3:00 p.m.-7:00 p.m. Saturdays: 10:00 a.m.– 2:00 p.m. *Phone: (800)922-2770x3730 *Email: lstore@gsofct.org
Wilton Shop: 27 Danbury Rd 3rd Floor Wilton, CT * Wednesday: 10:00 a.m.–4:00 p.m. Thursday: 10:00 a.m.–5:00 p.m. Friday: 10:00 a.m.–5:00 p.m. *Phone: (800)922-2770x3818 *Email: wstore@gsofct.org
If these location do not work, we can ship at your cost. Choose this option and a shop employee will be in touch!
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