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Girl Guidelines The Girl Scout Gold Award

Girl Scout Gold Award Project Proposal

Council Name___________________________________________________

Submit this form to your council [ ] weeks prior to starting your project.

Name: _________________________________________________________

Address: _______________________________________________________

City: _______________ State: _______ Zip code: ____________________

E-mail: _________________________ Phone: ____________________

Age: ____ Grade: ______ School: _________________________________

Troop/Group Number: _____ Troop/Group Volunteer: _________________

Troop/Group Volunteer’s Phone: (____ ) _____________ E-mail: __________

Girl Scout Gold Award Project Advisor: _________________________________

Project Advisor’s Organization: _______________________________________

Project Advisor’s Phone: (____ ) _____________ E-mail: __________________

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Girl Guidelines The Girl Scout Gold Award

Prerequisites: Two Senior or Ambassador journeys or one journey and the Girl Scout

Silver Award. List two journeys that you have completed along with your troop/group

volunteer’s signature.

Senior/Ambassador Journey Books

Date

Completed

Troop/Group Volunteer’s

Signature

1.

2.

Girl Scout Silver Award Completion Date

Council Where You Earned the Award

Your Team

List the names of individuals and organizations that you plan to work with on your

Take Action project. This is a preliminary list that may grow through the course of your

project.

More Team Members

Affiliation Role

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Girl Guidelines The Girl Scout Gold Award

Take Action Project

Project Title: _____________________ Proposed Start Date: ___________________

Proposed Completion Date: ________________________

A. Describe the issue your project will address and who is your target audience.

Remember your 15-second pitch.

B. Discuss your reasons for selecting this project.

C. Outline the strengths, talents, and skills that you plan to put into action. What skills

do you hope to develop?

D. Describe the steps involved in putting your plan into action, including resources,

facilities, equipment, and approvals needed. (Attach a detailed project plan.)

E. Enter the names of people or organizations you plan to inform and involve.

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Girl Guidelines The Girl Scout Gold Award

F. Estimate overall project expenses and how you plan to meet these costs.

G. What methods or tools will you use to evaluate the impact of your project?

H. How will your project be sustained beyond your involvement?

I. Describe how you plan to tell others about your project, the project’s impact, and

what you have learned (Web site, blog, presentations, posters, videos, articles, and

so on).

Your Signature: ________________________________ Date: ______________

Project Advisor’s Signature: ___________________________ Date: __________

Council Representative Approved: _______________________ Date: _________

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Girl Guidelines The Girl Scout Gold Award

Impact Planning

Using the Impact Planning Chart, describe the impact you hope your project will have

on your community, your target audience, and you.

Impact On . . . Goals Potential Impact Community What community issue do you

plan to address?

What examples of

the project impact

might you see in

future?

Target Audience

(workshop participants,

other youth, community

members, and so on)

What skills, knowledge, or

attitudes will your target

audience gain?

How will you know

that the target

audience gained

skills or knowledge?

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Girl Guidelines The Girl Scout Gold Award

The following is a list of the 15 Girl Scout Leadership Outcomes.* Which do think you

will develop through this project?

Discover:

I will develop a stronger sense of self.

I will develop positive values.

I will gain practical life skills.

I will seek challenges in the world.

I will develop critical thinking.

Connect:

I will develop healthy relationships.

I will promote cooperation and team building.

I will resolve conflicts.

I will advance diversity in a multicultural world.

I will feel more connected to my community, locally and globally.

Take Action:

I will identify community issues.

I will be a resourceful problem solver.

I will advocate for myself and others, locally and globally.

I will educate and inspire others to act.

I will feel empowered to make a difference in the world.

*Want more information on the Girl Scout Leadership Outcomes? Visit

www.girlscouts.org/research/publications/outcomes/transforming_leadership.asp.

GIRL SCOUT GOLD AWARD 

PROJECT ADVISOR AGREEMENT 

I, __________________________________________agree to participate as the           (please print your name) 

Project Advisor for Girl Scout  . (please print girl’s name) 

In doing this I will: 

• Understand the intent of her Gold Award Project.• Discuss the project with her.• Make sure that the project fulfills the goals of Girl Scouts of the USA and maintains

Safety­Wise standards.• Sign her Gold Award Project Application.• Assist her in planning, designing, facilitating, and evaluating the project.• Keep in close communication with her, but allow her to take the lead in bringing the

project to completion.• Make myself available for consultation and discussion.• Advise in the area of my expertise and support the program in its entirety.• Write an end‐of‐project evaluation relating to the Girl Scout Gold Award Final Project

Report.

______________________________________________________________________ Signature of Project Advisor 

______________________________________________________________________  Advisor’s Organization or Background 

______________________________________________________________________ Date Signed 

Note: This signed form is to accompany the Girl Scout Gold Award Proposal.

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GIRL SCOUT GOLD AWARD 

PARENT/GUARDIAN CONSENT 

For  

Girl Participation in Girl Scout Gold Award Project 

I, ________________________________________________________, give my permission for (Please print your name) 

________________________________________________ to participate in her Girl Scout     (Please print girl’s name) 

Gold Award Project.  

In giving permission, I will: 

• Have knowledge of the scope and intent of her project.

• Lend assistance when requested.

• Know or have met her Project Advisor.

• Provide on‐going support for her and her project.

___________________________________________________________________________   Signature of Parent/Guardian 

___________________________________________________________________________   Date Signed 

Note:  This signed form is to accompany the Girl Scout Gold Award Proposal. 

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GIRL SCOUT GOLD AWARD 

TROOP/GROUP ADVISOR AGREEMENT 

I, ____________________________________agree to participate as the Troop/Group Project(Advisor, please print your name) 

Advisor for the Girl Scout Senior/Ambassador ____________________________________. (Advisor, please print girl’s name) 

In doing this I will: 

• Understand the intent of her Girl Scout Gold Award Project.

• Discuss the Project with her.

• Make sure that the project fulfills the goals of Girl Scouts of the USA and maintains

Safety­Wise standards.

• Sign her Girl Scout Gold Award Project Application.

• Assist her in planning, designing, facilitating, and evaluating the project.

• Keep in close communication with her, allowing her to take the lead in bringing the

project to completion.

• Make myself available for consultation and discussion.

• Advise in the area of my expertise and support the program in its entirety.

Signature of Troop/Group Advisor 

________________________________________  ________________________ Troop/Group Number  Date Signed  

Note: This signed form is to accompany the Girl Scout Gold Award application. 

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GIRL SCOUT GOLD AWARD BUDGET 

Date _________________________ 

Name 

Project Name 

Expenses: 

Type of expense *  Dollar amount * 

_______________________  ______________________ 

_______________________  ______________________ 

_______________________  ______________________ 

_______________________  ______________________ 

Total_________________ 

*Additional expenses can be written on the reverse side of this page.

Income: (Projected) 

Resource    Projected income 

______________________ ______________________ 

______________________ ______________________ 

______________________ ______________________ 

______________________ ______________________ 

Total_________________ Comments: _________________________________________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________ 

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GOLD AWARD TAKE ACTION PROJECT

PROPOSED TIMELINE

Name ___________________________________________________________Date ________________

Advisor/Leader’s Name__________________________________________________________________

Month/Day/Year A C T I V I T Y Hours:Minutes

(Total number of required hours should be close to 80 hours) Total Hours 11

GOLD AWARD TAKE ACTION PROJECT

SAFETY-WISE STANDARDS PERTINENT TO MY PROJECT

Date: _______________

Name: ________________________________________________________________________

Take Action Project Title: _________________________________________________________

# (SAFETY-WISE STANDARDS/SAFETY ACTIVITY CHECKPOINT) PAGE/S

(Please use additional pages, if needed)

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