* 1. Nominator's Information

* 2. Are you a registered member?

* 3. What is your affiliation with Girl Scouts?

* 4. Are you nominating a girl?

* 5. Girl Scout's Name

* 6. Are you nominating an entire troop?

* 7. What is the Troop Number?

* 8. What is the Service Unit number?

* 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)

* 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.

* 11. Additional Comments