* 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