Name:
Region (refer to map of regions PDF): Select One Region 1: South Region 2: West Region 3: East Region 4: North Service Unit:
Street address:
City: State: ZIP:
Home Phone: Cell Phone: Work Phone:
Email:
I give permission to share contact information with other Regional Delegates: Yes No
Years registered as an adult:
Years registered as a girl:
The information in this application form will be used for biographical information on the ballots, planning for training, development of regional meeting agenda and priorities, and to help inform the future work of the governance committee. Thank you!
I would be willing to serve an additional: 1 year 2 years 3 years
Able to be objective, representing the best interests of the Girl Scout Movement, not just a particular geographic area or program level Definitely Somewhat Limited
Understand the role of Governance in the organization Definitely Somewhat Limited
Able to participate as a member of a team Definitely Somewhat Limited
Able to speak in front of small and large groups Definitely Somewhat Limited
Willing to attend service unit, neighborhood, or other meetings Definitely Somewhat Limited
Why are you interested in being a regional delegate?
What other positions outside of Girl Scouts have you held which would support you in the role of Regional Delegate?
By clicking "Send", I certify that I have read the position description (PDF) for GSEM Regional Delegate. If elected, I am willing to serve as a delegate or alternate and I able to fulfill all the duties listed
