Girls Who Do a World of Good Question Title * 1. Nominator's Information Name: * Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Email Address: * Phone Number: * Question Title * 2. Are you a registered member? Yes No Question Title * 3. What is your affiliation with Girl Scouts? Parent Troop Leader Service Unit Volunteer Other Other (please specify) Question Title * 4. Are you nominating a girl? Yes No Question Title * 5. Girl Scout's Name Question Title * 6. Are you nominating an entire troop? Yes No Question Title * 7. What is the Troop Number? Question Title * 8. What is the Service Unit number? Question Title * 9. List the name of each girl in the troop (use the comment box at the end of the survey if you have more than seven girls) Name of Girl Name of Girl Name of Girl Name of Girl Name of Girl Name of Girl Name of Girl Question Title * 10. Give a brief description of the service project. *Please send an image of the girl or troop to media@gscnc.org to be used on our Website and Facebook page to honor the recipients. Question Title * 11. Additional Comments Done