Parent/Guardian Name Phone Address. Girl Scout Reference Name Phone Address. Community Reference Name Phone Address

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1 Leader of Tomorrow Scholarship Application 1 of 6 Please use the spaces provided to type your answers. Any incomplete or unanswered questions will automatically result in immediate disqualification of your Leader of Tomorrow Scholarship for Graduating Girl Scouts Application. Any illegible information will automatically result in the immediate disqualification of your application. After completing the form and answering all of the questions, your application must be submitted via hand delivery or U.S. mail to the Leader of Tomorrow Scholarship Committee/Teen Girl Experience Specialist by APRIL 15, for consideration for the following membership year. Please remember to include a copy of your SEALED OFFICIAL HIGH SCHOOL TRANSCRIPT. SUBMIT THIS FORM VIA HAND DELIVERY OR U.S. MAIL TO: Girl Scouts of Southwest Texas Leader of Tomorrow Scholarship Sally Cheever Girl Scout Leadership Center 811 North Coker Loop San Antonio, Texas CONTACT INFORMATION: Received: Approved: COUNCIL USE ONLY First Name Last Name Community Troop Street Address City Zip Code Home Phone Cell Phone Address Name of High School GPA (4.0 scale) Years in Girl Scouts Age Parent/Guardian Name Phone Address Parent/Guardian Name Phone Address Girl Scout Reference Name Phone Address Girl Scout Reference Service Unit Troop Position Community Reference Name Phone Address Community Reference Organization Position

2 Leader of Tomorrow Scholarship Application 2 of 6 SHORT ANSWER QUESTIONS: All of the short answer questions must be completed on a separate page. The page should be a typed document, size 12, Arial, black font, with your name typed in the top right-hand corner of each page. Please limit your responses to the suggested space requirement. 1. How many years have you been a member of Girl Scouts? 2. What is your current Grade Point Average (GPA) on a 4.0 scale? Please remember to include a copy of your sealed official high school transcript. 3. List your other awards and/or achievements outside of Girl Scouts. (¼ page length) 4. List your classroom and extracurricular activities and roles outside of Girl Scouts. (½ page length) 5. List your religious and community activities and roles outside of Girl Scouts. (¼ page length) 6. List your individual interests and hobbies. (¼ page length) 7. Describe your future education and career goals. (½ page length) 8. How will you incorporate into your daily life what you have experienced and learned in Girl Scouting to show your commitment to making the world a better place? (¼ page length) 9. Please remember to sign and date at the bottom of your short answer responses. APPLICANT INFORMATION: Race/Nationality (voluntary disclosure) Religion Place of Worship School you attend Principal Phone Graduation Year of Birth Age College/University you plan or hope to attend Majors or specializations you plan to study Parent/Guardian 1 Full Name Employment Contact Parent/Guardian 2 Full Name Employment Contact A brief three (3) to five (5) sentence description of and statement about your future education plans, career goals, and how Girl Scouts has impacted your life:

3 Leader of Tomorrow Scholarship Application 3 of 6 SCHOLARSHIP REFERENCES: Please use the form below or ask your reference to type answers on a separate page using size 12, Arial, black font. Girl Scout Reference Name Phone Address Girl Scout Reference Service Unit Troop Position Street Address City Zip Code 1. How do you know the applicant? 2. How do you feel the applicant demonstrates the Girl Scout promise and law in their daily life? Girl Scout Reference Signature Thank you for submitting a reference for the scholarship committee to review. THE GIRL SCOUT PROMISE On my honor, I will try: To serve God and my country, To help people at all times, And to live by the Girl Scout Law THE GIRL SCOUT LAW I will do my best to be honest and fair, friendly and helpful, considerate and caring, courageous and strong, and responsible for what I say and do, and to, respect myself and others, respect authority, use resources wisely, make the world a better place, and be a sister to every Girl Scout.

4 Leader of Tomorrow Scholarship Application 4 of 6 SCHOLARSHIP REFERENCES: Please use the form below or ask your Community Reference to type answers on a separate page using size 12, Arial, black font. Community Reference Name Phone Address Community Reference Organization Position Street Address City Zip Code 1. How do you know the applicant? 2. How do you feel the applicant demonstrates the Girl Scout promise and law in their daily life? Community Reference Signature Thank you for submitting a reference for the scholarship committee to review. THE GIRL SCOUT PROMISE On my honor, I will try: To serve God and my country, To help people at all times, And to live by the Girl Scout Law THE GIRL SCOUT LAW I will do my best to be honest and fair, friendly and helpful, considerate and caring, courageous and strong, and responsible for what I say and do, and to, respect myself and others, respect authority, use resources wisely, make the world a better place, and be a sister to every Girl Scout.

5 PUBLICITY RELEASE: Leader of Tomorrow Scholarship Application 5 of 6 For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I hereby consent and agree to the following: 1. I hereby grant to Girl Scouts of the USA (GSUSA), and others working for GSUSA or on its behalf, and each of its respective licensees, successors, and assigns (each a Releasee ), the irrevocable, royalty-free, perpetual, unlimited right and permission to use, distribute, publish, exhibit, digitize, broadcast, display, modify, create derivative works of, reproduce or otherwise exploit my name, picture, likeness, and voice (including any video footage of the same) (collectively Media), or to refrain from so doing, anywhere in the world, by any persons or entities deemed appropriate by GSUSA, for any purpose (except defamatory) including, without limitation, any use for educational, advertising, non-commercial or commercial purposes in any manner or media whatsoever (whether known or hereafter devised) including, without limitation, on the internet, in print campaigns, in-store and via television. I agree that I have no interest or ownership in any of the Media. 2. I shall have no right of approval, no claim to compensation and no claim (including, without limitation, claims based upon invasion of privacy, defamation or right of publicity) arising out of any use, alteration, blurring, illusionary effect or use in any composite form of my name, picture, likeness, and voice. I agree that nothing in this Release will create any obligation on GSUSA to make any use of the Media or the rights granted in this Release. I hereby release and hold harmless Releasees from any claim for injury, compensation, or negligence resulting or arising from any activities authorized by this Release and any use of the Media by GSUSA. Applicant Signature Parent/Guardian Signature AFTER COMPLETION, SUBMIT THIS FORM, YOUR TWO LETTERS OF RECOMMENDATION FROM YOUR GIRL SCOUT REFERENCE AND YOUR COMMUNITY REFERENCE, A COPY OF YOUR SEALED OFFICIAL HIGH SCHOOL TRANSCRIPT, AND SEPARATE SHORT ANSWER RESPONSES VIA HAND DELIVERY OR U.S. MAIL TO: Girl Scouts of Southwest Texas Leader of Tomorrow Scholarship Sally Cheever Girl Scout Leadership Center 811 North Coker Loop San Antonio, Texas 78216

6 Leader of Tomorrow Scholarship Application 6 of 6 SIGNATURE PAGE: I understand and agree to abide by the Girl Scouts of Southwest Texas and GSUSA guidelines for my scholarship application, consideration, and receipt. If I am awarded the scholarship, I will use the funds for the either the fall or spring semester at a college or university in the following membership year (i.e. I was awarded in spring of 2015, I will use the funds for the fall semester of 2015 or the spring semester of 2016). My signature on this document allows Girl Scouts of Southwest Texas the ability to use photographs, voice, and/or video of my child for Girl Scout public relations. Applicant Signature Parent/Guardian Signature COMMITTEE USE ONLY Committee Member Notes Follow Up