1. Program Provider Application

Thank you for your interest in working as a Program Provider for the Girl Scouts Carolinas Peaks to Piedmont Council. The position you are applying for is a part-time, temporary (seasonal) hourly position working with our outreach Girl Scout members through community partner sites such as the Boys and Girls Club and Housing Authorities.

* 1. Name

* 2. Outreach programs are conducted at community sites such as the Boys and Girls Clubs and Housing Authorities in the following cities. Which of the Girl Scouts Carolinas Peaks to Piedmont outreach sites would you like to work at?

  1st Choice 2nd Choice 3rd Choice
Winston Salem
High Point

* 3. Current Contact Info

* 4. Permanent Contact Info (if applicable)

* 5. Present Occupation or Year In School

* 6. Dates Available


* 7. Email Address

* 8. How often do you check your email?

* 9. Where did you hear about the positions available?

* 10. Have you ever been convicted of a crime (other than a minor traffic violation)?

* 11. If yes, please state offense, date and location.
A conviction record will not necessarily be cause for disqualification, but failure to disclose may be.

* 12. Are you able to get yourself to and from the work site?

* 13. Do you hold a current US Driver’s License?