1. business and industrial

THE AMERICAN LEGION, DEPARTMENT OF INDIANA
GOLD AWARD GIRL SCOUT OF THE YEAR
SCHOLARSHIP ACHIE VEMENT AWARD – 2014-15
AWARD:
$1,000 scholarship and trip to the Department of Indiana Convention to receive award.
Each District winner will receive a $200 scholarship.
REQUIREMENTS:

Must be an Indiana resident and a United States Citizen;

Must either be in or graduate from high school during the year of the competition;

Must be a registered Girl Scout (copy of current-year Girl Scout membership card must be
submitted with application);

Must have received the Girl Scout Gold Award (proof of receipt, or of requirements completed,
must be submitted with application);

Must have received the appropriate religious emblem, appropriate Girl Scout level (proof of
religious award must be submitted with application);

Must have demonstrated good and practical citizenship in her Girl Scouting, school, religious
institution and community;

Must submit at least four letters of recommendation and testimony with the application, with one
letter from a leader in each of the following groups: Scouting, school, religious institution and
community;

NOTE: State-level award winners may not reapply for this Girl Scout Scholarship.
SELECTION PROCESS:

Applicant must present the completed application to the American Legion Girl Scout Committee
Chairman of the District covering the county where the applicant lives on or before MAY 1,
2015 (see enclosed list of District Chairmen).

Each District Girl Scout Chairman is to select a screening committee of American Legion
members in order to select a single nominee from their District. This nominee must be submitted
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to the Department Girl Scout Committee Chairman by JUNE 1, 2015. There may be up to eleven
nominees at Department level: one from each District in Indiana.

The Department Girl Scout Chairman will select a screening committee of Girl Scout Leaders,
educators and American Legion members to review and rank the nominations to select a winner,
which will be final. The winner will be notified and requested to attend the Department of
Indiana Convention on JULY 11, 2015, at the expense of the American Legion, to receive the
Scholarship Achievement Award.
SCHOLARSHIP ACHIEVEMENT AWARD:
The scholarship recipient will be eligible to receive her scholarship after graduation from high
school and must utilize the award within one year of date of graduation (or date of award if she has
already graduated). The scholarship must be used to attend a school that is state accredited and
above high school level and within the United States. Disbursement will be made directly to the
scholarship recipient at the beginning of the first semester upon receipt of certification from the
school that the recipient is enrolled in as a full time student. The notice of certification must be
made to the Department Girl Scout Committee Chairman. This requirement applies to both the
Department and District winners.
APPLICATION:
Name of Applicant____________________________________________________________________
Street Address_______________________________________________County___________________
City___________________________________________ State_____________ Zip____________
Telephone No._____________________________ Age____ Date of birth________________________
Name of High School_______________________________________________ Grade______________
Present grade point average_________________ Year of graduation______________________
Name of college or university you hope to attend____________________________________________
Date Girl Scout Gold Award received (or requirements completed if not received)_________________
Girl Scout Council issuing Gold Award_______________________________________________
List Scouting achievements_____________________________________________________________
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____________________________________________________________________________________
____________________________________________________________________________________
Name of religious award received________________________________________________________
List leadership positions and honors received from your Girl Scout Troop or Council, school, religious
institution, and community.
Leadership positions
Honors
_____________________________________
________________________________________
_____________________________________
________________________________________
_____________________________________
________________________________________
Describe your involvement in each of the following. Use attachments if necessary:
Your religious institution_______________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Your school__________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Your community______________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Your Gold Award project_______________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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NOTE: Please be sure to attach any required materials to this application and submit to the American
Legion District Girl Scout Chairman covering your Girl Scout Council no later than MAY 1, 2015.
APPLICANT CERTIFICATION: I certify to the accuracy of the foregoing facts and information. If
selected as the Department winner, I will be free to travel to the American Legion Department of
Indiana Convention in Indianapolis, IN on JULY 11, 2015 to receive the Award.
Signature of Girl Scout___________________________________________
Date______________
PARENT’S CONSENT: I (we) hereby certify that the information pertaining to our daughter’s age
and grade in school is correct. In consideration of the benefits derived from this honor, if selected, we
hereby voluntarily waive any claim against the American Legion Department of Indiana and the Girl
Scouts of the U.S.A. totally and all representatives thereof.
Signature of Parent or Guardian_____________________________________
Date______________
GIRL SCOUT LEADER: The above named applicant is qualified in every respect to represent the
American Legion Department of Indiana and the Girl Scouts of the U.S.A. and has our recommendation.
Signature of Girl Scout Leader______________________________________
Date______________
AMERICAN LEGION DISTRICT GIRL SCOUT CHAIRMAN: The above named applicant is
approved by District No.______ of Indiana as qualified for the nomination for the American Legion
Department of Indiana Gold Award Girl Scout of the year Scholarship Achievement Award for the year
2015.
Signature of District Chairman______________________________________
Date______________
AMERICAN LEGION DEPARTMENT OF INDIANA DEPARTMENT GIRL SCOUT
CHAIRMAN: The above named applicant has been selected for the American Legion Department of
Indiana Gold Award Girl Scout of the year Scholarship Achievement Award.
Signature of Department Chairman__________________________________
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Date______________
THE AMERICAN LEGION, DEPARTMENT OF INDIANA
GIRL SCOUT COMMITTEE
6th District Chairman: Veronica Spencer – Warren,
Vermillion, Fountain, Parke, Vigo, Montgomery,
Putnam, Boone, Hendricks, Hamilton Counties
PO Box 352, New Market IN 47965
Ph: 765-866-0701
Email: [email protected]
Department Chairman: Gail Galich
3541 Jewett Street, Highland, IN 46322
Ph: 219-923-5537
Email: [email protected]
Vice Chairman: Daniel Lee
25 Rivercrest Drive, Osceola, IN 46561
Ph: 574-315-1581
Email: [email protected]
7th District Chairman: Harold Hensley – Sullivan,
Knox, Gibson, Clay, Greene, Owen, Daviess, Martin,
Morgan, Monroe, Johnson Counties
2326 E Navajo Dr., Vincennes IN 47591
Ph: 812-886-0145
Vice Chairman: Kimberly Mezger
1702 Harvest Meadow Drive, Greenwood, IN 46143
Ph: 317-507-2756
Email: [email protected]
8th District Chairman: Shirley Ohta – Posey,
Vanderburgh, Pike, Warrick, Dubois, Spencer, Perry,
Crawford, Harrison, Floyd, Clark Counties
5024 Bent Creek Dr., Floyds Knobs, IN 47119
Ph: 812-923-9863
Email: [email protected]
1st District Chairman: Gail Galich – Lake County
3541 Jewett St., Highland, IN 46322
Ph: 219-923-5537
Email: [email protected]
2nd District Chairman: Larry Burkhart – Newton,
Jasper, Benton, Porter, Starke, Pulaski, White,
Tippecanoe, Carroll, Cass, Fulton, Kosciusko Counties
1227 E. Ft. Wayne Street, Warsaw, IN 46580
9th District Chairman: William Scharold – Lawrence,
Orange, Brown, Jackson, Washington, Bartholomew,
Jennings, Scott, Franklin, Ripley, Jefferson, Dearborn,
Ohio, Switzerland Counties
2089 Lamplight Dr., Lawrenceburg IN 47025
Ph: 812-637-0644
3rd District Chairman: Daniel Lee – LaPorte, Joseph,
Elkhart, Marshall Counties
25 Rivercrest Drive, Osceola, IN 46561
Ph: 574-315-1581
Email: [email protected]
10th District Chairman: Ida Jewell – Hancock, Shelby,
Delaware, Henry, Rush, Decatur, Randolph, Wayne,
Fayette, Union Counties
12128 Springfield Rd., Bath IN 47010
Ph: 765-277-0334
Email: [email protected]
4th District Chairman: James Timpe – LaGrange,
Noble, Whitley, Steuben, Dekalb, Allen, Wells, Adams
Counties
1450 S. 418 W., Angola, IN 46703
Ph: 260-668-7457
Email: [email protected]
11th District Chairman: Joseph Komenda – Marion
County
6049 Harlescott, Indianapolis, IN 46220
Ph: 317-849-0716
Email: [email protected]
5th District Chairman: Paul Layman – Clinton, Howard,
Tipton, Miami, Wabash, Grant, Madison, Huntington,
Blackford, Jay Counties
503 S. 1st St., Van Buren IN 46991
Ph: 765-603-0213
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