Thank you for participating in Girl Scouts for Community Change and PBNYC 2019! This form is required to get your patch for participating—be sure to submit your PBNYC idea online or through a Council Member before filling it out. You can learn more about PBNYC at https://council.nyc.gov/pb/, and submit ideas online at http://ideas.pbnyc.org.

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* 1. Is a Girl Scout or parent filling out this survey?

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* 2. The project idea is...

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* 3. The approximate location of the project is...

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* 4. What problem is the project idea solving?

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* 5. Please confirm this idea was submitted to PBNYC:

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* 6. How many Girl Scouts contributed to this idea?

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* 7. Please provide Girl Scout(s) names:

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* 8. Their Girl Scout level(s) is/are:

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* 9. Troop number(s)

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* 10. What is the best email to contact to learn more about this idea?

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* 11. Mailing address for patch(es)

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* 12. FOR PARENTS: Do you consent to have this project idea, along with Girl Scout(s)' first name and troop number, shared on GSGNY's social media channels?

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* 13. Have the Girl Scouts who contributed to this project ever participated in PBNYC before?

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* 14. Are the Girl Scouts who contributed to this project likely to participate in PBNYC in the future?

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