Girl Scouts of Connecticut: Council Delegate Application

Application for Council Delegate

Please complete the following information: (note, fields marked * are required)

Name*

E-mail*

Address*

City*

Zip*

Home Phone*

Work/Alternate Phone

Race/Ethnicity*

Age Group*

Region Number*

Candidate Experience
Girl Scout Experience: list present and most recent first.
Position	Location	Date(s)



Other Volunteer Organizations:
Position	Location	Date(s)



Employment History:
Position	Location	Date(s)



Education:
School	Degree	Date(s)



Other Pertinent Information: List present and most recent first.
Position	Location	Date(s)



Why Do You Want to be a Delegate?

I am interested and able to perform the duties of a Delegate for my Region for the following terms (please specify term; select as many as applicable)

	One year
	Two years
	Three years

I agree that, if elected, I will carry out the responsibilities of a Delegate as outlined in the Bylaws and will represent my Region as an informed Delegate.

Application for Council Delegate

Candidate Experience