Girl Scouts of Eastern Pennsylvania

Attn: ADULT DEVELOPMENT COORDINATOR

P.O. Box814

Valley Forge, PA19482

LEADERSHIP DEVELOPMENT PIN APPLICATION

Requirements:

  1. Applicant is currently registered as a Leader orAssistant Leader. (GSUSA Position Codes 01 or 02)
  2. Applicant has completed required leadership training: Step 1 - GSUSA Online Volunteer Orientation, Step 2 - GSEP Volunteer Essentials and Step 3 - GSEP Leadership Essentials.
  3. Applicant has participated in at least two meetings beyond the troop.
  4. Applicant has completed, or applicant has secured resource personnel who have completed Outdoor Training and First Aid/CPR Training. All training must be current.

Application Procedures:

  1. To receive the Leadership Development Pin, the applicant must meet all the requirements listed above prior to completing this form.
  2. Complete the form and submit to above address. Application will be reviewed by council representative.
  3. If applicant has successfully met the requirements of this earned recognition, she/he will receive a confirmation letter which will authorize purchase of this pin.
  4. Pins may be purchased at any GSEP Council Shop by submitting the letter.

Pins may not be purchased without submitting the original confirmation letter.

APPLICANT INFORMATION

Please give full name as it appears on Membership Registration.

Circle the current GSUSA position code of applicant: 01 02

Name: GSUSA ID #:

Address:

StreetCity State Zip Code

E-mail:

Daytime Telephone:Evening Telephone:

Date of First Appointment as a Troop Leader or Assistant Leader:

TROOP/GROUP INFORMATION

Troop/Group Number: Troop/Group Level:

Troop Leader (01):

Assistant Troop Leader (02):

Service Unit Mgr: Membership Mgr:

Service Unit Name and # :

A.TRAINING

Applicant has completed required leadership training.

Training / Location / Date Completed
Step 1
GSUSA Online Volunteer Orientation
(formerly Basic Orientation)
Step 2
GSEP Volunteer Essentials
(formerly Volunteer Orientation)
Step 3
Girl Scout Leadership Essentials

B.MEETING ATTENDANCE

Applicant has attended at least two meetings beyond the troop. (Service Unit Meetings, Service Team Meetings, GSEP Annual Meeting, etc.)

Type of Meeting / Location / Date

C.FIRST AID/CPR AND OUTDOOR TRAINING

Applicant has completed, OR applicant has secured resource personnel who have completed Outdoor Training and First Aid/CPR Training. All training must be current!

Position / Name of Trained Adult(s) / Location/Course Title / Course Date / Expiration Date
Outdoor Trained Person
First Aider / First Aid:______
CPR:______

Please direct questions about this application to:

Teresa Van Arsdale, Adult Development Coordinator at r (610) 933-7555,x-1452.

Signature of Applicant: Date:

TO BE COMPLETED BY ADULT DEVELOPMENT STAFF

Applicant has______has not______completed the requirements for the Leadership Development Pin.

GSEP Authorized Signature: Date:

System Entry Date: By:

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