Council Level Recognition Nomination Form

Council Level Recognition Form

"*" indicates required fields

Our recognition ceremony recognizes those volunteers who provide exemplary service and go above and beyond the expectations of their position to make a difference for the organization and for Girl Scouts. This form is to be used to nominate an adult volunteer for a council level recognition award. The nomination is for the work performed during the 2025-2026 membership year.

Nomination Steps:

Decide which award is appropriate for the service.
- Review both the National & Council Volunteer Award Handbook and the Volunteer Award Reference Guide to determine award eligibility and impact of service.
- Include specific information that relates to the service and its scope of impact.
- Gather candidate's contact information including address, phone number, email, and service unit.
- Submit nomination only through council's eForm.
Gather the contact information for supporting endorsements.
- Notify the contacts that you have submitted their information to support the nomination.
- Provide their contact information such as name, email address, and phone number.
- Supporting endorsements vary by award. Please enter appropriate number of contacts to fulfill this requirement.
Submit the nomination via this eForm.
- Deadline to submit is the first Friday in December.
- Supporting endorsements will receive an email to submit by second Friday in December via eForm.
- Nomination should remain a secret from the candidate in case the nomination is not approved.

Contact adultrecognitions@girlscoutsla.org if you have any questions.

Application Date

Nominee Information

Nominee Name*

First Last

Nominee Position*

Nominee Mailing Address*

Street Address City State ZIP Code

Nominee Phone Number*

Nominee Email Address*

Enter Email Confirm Email

Nominee Region*

Is the nominee associated with a service unit?*

Yes

Unsure

Nominee Service Unit*

Submitter Information

Submitter Name*

First Last

Submitter Present Girl Scout Position (if applicable)

Submitter Mailing Address*

Street Address City State ZIP Code

Submitter Phone Number*

Submitter Email Address*

Enter Email Confirm Email

Submitter Region*

Submitter Service Unit

Award Level

Please choose the award type (both may be selected):*

Membership and Service Pins

Council and National Award

Select Numeral Guard for: 30 years+ as a registered Girl Scout - girl/adult

Select Years of Service for: 25 years+ as a registered Adult volunteer

Which Membership and Service Pin (both may be selected)?*

Numeral Guard

Years of Service

Numeral Guard*

Select the number of girl and adult years rounded down to an increment of 5 years. (For 5 - 25 years use Service Unit form).

Years of Service Pin*

Select the number of active only years rounded down to an increment of 5 years. Note, it goes up in increments of 10 years after 40 years.

Which Council and National Award?*

Select the type of award this nomination applies to. Only one award per nomination.

Was the contribution beyond the Troop level?*

Yes

* The Appreciation Pin requires service beyond the troop level, therefore this application will be denied. Please select another award level.

Was the service provided to two or more Service Units?*

Yes

* The Honor Pin requires service be provided to two or more service units, therefore this application will be denied. Please select another award level.

Was the service provided to their Service Unit or a region or the entire council?*

Yes

* The Platinum Service Award requires service be provided to their Service Unit or a region or the entire council for at least three years since receiving the Appreciation Pin and either Honor Pin or Thanks Badge, therefore this application will be denied. Please select another award level.

Has the candidate taken a leadership role at the council level during the previous four years?*

Yes

* The Thanks Badge requires service be provided in a leadership role at the council level in one or more areas during the previous four years, therefore this application will be denied. Please select another award level.

Has the candidate received the Thanks Badge?*

Yes

* The Thanks Badge II requires candidate has been awarded the Thanks Badge, therefore this application will be denied. Please select another award level.

Nomination

This nomination should remain a secret from the nominee in case the nomination is not approved.

Should this award be approved it will be presented at the Volunteer Recognition Ceremony. The recipient will be provided with a copy of the nomination and endorsements submitted. Recipients may be given their supporting nominations and application. The recipient will receive an invitation to attend the ceremony.

Appreciation Pin

Please describe how the nominee has contributed and benefited at least one Service Unit or program delivery
audience (i.e. product program, membership etc…). Be detailed and as specific as possible listing qualifications and particular instances. Please be sure your answers support the above stated criteria to qualify for this award. You will need to provide the name and email information of two people to support this nomination.

1A. Describe the nominee's contributions and who benefited from them. Include examples of how they demonstrated inclusive behavior and helped create a welcoming environment for others.*

2A. How did the nominee's efforts help advance GSGLA goals, such as membership growth, retention, fund development, product programs, or community visibility?*

3A. Explain how the nominee went above and beyond the normal responsibilities of their role. Include specific examples.*

Honor Pin

Please describe how the nominee has contributed and benefited at least two or more Service Units or a Region. Be detailed and as specific as possible listing qualifications and particular instances. Please be sure your answers support the above stated criteria to qualify for this award. You will need to include the name and email of three additional people supporting the nominee’s service.

1H. Describe the volunteers’ contributions and their impact. Include how the candidate actively recognizes, understands, and practices the values of inclusive behavior.*

2H. What measurable impact did the nominee's efforts have on Girl Scouting? Consider membership growth, volunteer support, fund development, program opportunities, or community visibility.*

3H. Explain how the nominee went above and beyond the normal responsibilities of their role. Include specific examples.*

Platinum Service Award

Please describe how the nominee has contributed and benefited a Service Unit, a Region or the entire Council for three years after receiving the Appreciation Pin and either the Honor Pin or Thanks Badge. You will need to include the name and email of three additional people supporting the nominee’s service.

Year Appreciation Pin Awarded*

Which of the following has the nominee received?*

Honor Pin

Thanks Badge

Both Honor Pin and Thanks Badge

Year Honor Pin Awarded*

Year Thanks Badge Awarded*

1P. Describe the nominee's contributions to their Service Unit. Include their role(s), years of service, and specific ways they made a difference.*

2P. Describe contributions made and in what way it benefited the Region or entire Council, include position title(s) and dates.*

3P. Explain how the nominee went above and beyond the normal responsibilities of their role. Include specific examples.*

4P. How has the nominee served as a positive role model for other volunteers? Include examples of leadership, mentorship, or living the Girl Scout Promise and Law.*

Thanks Badge

Please describe how the nominee has contributed and benefited the entire Council or entire Girl Scout Movement. Be detailed and as specific as possible listing qualifications and particular instances. Please be sure your answers support the above stated criteria to qualify for this award. You will need to provide the names and emails of four additional people supporting the nominee’s service.

1T. Describe the nominee’s contributions and how they benefitted the entire Council or Girl Scout Movement. Include how the candidate has taken a leadership role at the council level during the previous four years in one or more of the following areas: membership, adult generated funding, innovative programs, influencing policy, inclusive behavior.*

2T. Explain how the nominee went above and beyond the normal responsibilities of their role. Include specific examples.*

Thanks Badge II

Please describe how the nominee has contributed and benefited the entire Council or entire Girl Scout Movement. Be detailed and as specific as possible listing qualifications and particular instances. Please be sure your answers support the above stated criteria to qualify for this award. You will need to provide the names and emails of four additional people supporting the nominee’s service.

1T2. Date the "Thanks Badge" was awarded*

2T2. Describe the contribution and who benefited – GSGLA or GSUSA. Include how the candidate has taken a leadership role at the council level, increased the sphere of influence, or used skills and talents to move into another field of endeavor during the previous three years.*

3T2. Explain how the nominee went above and beyond the normal responsibilities of their role. Include specific examples.*

Heart in Hand Award

1HiH. Describe how the candidate's unique expertise contributed and demonstrated outstanding and meaningful service that has significantly benefited the council, region, or multiple service units.*

Supporting Nomination Contact Information

Name of Supporting Nomination Contact #1*

First Last

Please enter the name of a person who is willing to support this nomination.

Email address of Supporting Nomination Contact #1*

Please enter the email address of the person who is willing to support this nomination.

Name of Supporting Nomination Contact #2*

First Last

Please enter the name of a person who is willing to support this nomination.

Email address of Supporting Nomination Contact #2*

Please enter the email address of the person who is willing to support this nomination.

Name of Supporting Nomination Contact #3*

First Last

Please enter the name of a person who is willing to support this nomination.

Email address of Supporting Nomination Contact #3*

Please enter the email address of the person who is willing to support this nomination.

Name of Supporting Nomination Contact #4*

First Last

Please enter the name of a person who is willing to support this nomination.

Email address of Supporting Nomination Contact #4*

Please enter the email address of the person who is willing to support this nomination.

Name of Supporting Nomination Additional Contact #1

First Last

Optional: You can enter the name of an additional person who is willing to support this nomination.

Email of Supporting Nomination Additional Contact #1

Optional: You can enter the name of an additional person who is willing to support this nomination.

Name of Supporting Nomination Additional Contact #2

First Last

Optional: You can enter the name of an additional person who is willing to support this nomination.

Email of Supporting Nomination Additional Contact #2

Optional: You can enter the name of an additional person who is willing to support this nomination.

By clicking yes, I'm acknowledging that I've entered all information correctly to the best of my knowledge.*

Yes

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Council Nomination Reference Number

GSGLA volunteer

GSGLA volunteer

Council Level Recognition Nomination Form

Council Level Recognition Form

Nominee Information

Submitter Information

Award Level

Select Numeral Guard for: 30 years+ as a registered Girl Scout - girl/adult

Select Years of Service for: 25 years+ as a registered Adult volunteer

Nomination

Supporting Nomination Contact Information