Regional Chair Application

Personal Information

Name:*

First Name

Last Name

Email Address:*

Address:*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone Number (Cell):*

Phone Number (Home):

Employment/Profession (if applicable):

Service Unit:*

GSCTX Region:*

Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Region 7 Region 8

Tell us about yourself. You may include current and past Girl Scout involvement, community involvement, professional or school involvement.*

As Regional Chair of Girl Scouts of Central Texas, how do you envision communicating with Council Delegates in your region?*

Share your experience in leading groups and facilitating meetings.*

Number of Terms as a Council Delegate:*

Reference 1 Name:*

First Name

Last Name

Reference 1 Email Address:*

Reference 1 Phone Number:*

Reference 2 Name:*

First Name

Last Name

Reference 2 Email Address:*

Reference 2 Phone Number:*

Signature*

Use your mouse or finger to draw your signature above

Date:

Verification of no council debt.

Current criminal background check.

CFO Signature: