Girl Scout Council of the Mid-South


	Outstanding New 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:

Troop Number:

Age Level (check one):

Daisy Brownie Junior Teen (11-17 years old)

Candidate is registered as (check one):

Leader/Advisor Co-leader Assistant Leader Group Leader

Orientation Training Date:

Age Level Training Date:

Date of troop registration:

Participated in Girl Scout Cookie Sale:

Yes No

List the service unit and council program events in which the troop has participated:

Event	Date

Provide other information that illustrates this person's accomplishments.

Person Completing form First Name:*

Last Name:*