Girl Scout Council of the Mid-South

Outstanding Leader Award Nomination Form

Fields marked with an asterisk * are required.
Nominee's First Name:*
Nominee's Last Name:*
Address:*
City:*
State:*
Zip:*
Home Phone: 
Work Phone: 
E-mail Address: 
Orientation Training Date: 
Age Level Training Date: 
The information contained in the nomination should be objective and result-oriented, giving pertinent facts, dates, positions held, etc. State clearly and concisely the candidate's outstanding leadership skills, communication skills (at council, service unit, troop levels), and membership skills.
1. Describe service:
2. Provide information about the audience benefiting from the service and the
      impact the service has had on the delivery of the Girl Scout program:
Two letters of endorsement from members of the troop or their families are necessary to complete nomination. They may be submitted online or mailed or faxed to the Girl Scout Council of the Mid-South.
Person Completing form:
First Name:*
Last Name:*
Address:*
City:*
State:*
Zip:*
Home Phone:*
Work Phone: 
E-mail Address: 

                             
You may submit form electronically by clicking submit or print and deliver to the
Girl Scout Council of the Mid-South
Mail: PO Box 240246, Memphis, TN 38124-0246
Deliver: 2715 Kirby Parkway, Suite 1
Fax: (901) 797-2183