Emerging Leaders Interest Form Emerging Leaders provides access to unique opportunities only Girl Scouts can deliver, connecting you to a dynamic network of women leaders and a peer group who share similar special interests. Through Emerging Leaders, you can pick your passion by creating a pathway for participation based on your areas of interest. Emerging Leaders programming includes: Small group mentoring opportunities Career Exploration workshops Social Impact skill development Educational pathways for Life Beyond High School Sign up below to start your journey!Girl InformationGirl Name:* First Last Girl Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Girl Email:* Enter Email Confirm Email Home or Cell Phone:*Grade:*6789101112Age:*Are you a current Girl Scout?* Yes No Which of the following apply:* I am a member of a troop I am an individually registered girl Girl Scout Program Level:*Cadette 6-8Senior 9-10Ambassador 11-12Troop Number (Five Digits):*Parent/Guardian InformationParent/Guardian Name:* First Last Parent/Guardian Email:* Enter Email Confirm Email Parent/Guardian Home or Cell Phone:*This field is hidden when viewing the formParticipationThis field is hidden when viewing the formAre you interested in participating in the new Emerging Leaders Mentorship Program in October 2022? Each session will take place once a week from 6-7 p.m. over the course of 3 weeks in October and into the first week of November. There will be one Mentor per 4-5 Girl Scouts, or two Mentors per 8-10 Girl Scouts. The cost for participation is $5 and a registration link will be emailed to you once you are matched with a mentor.* Yes No This field is hidden when viewing the formPlease select your 1st choice of mentor topic.* Engineering, Architecture, and Construction Entertainment Game Development, App Development & Technology General - Women in Business Health & Beauty Mental Health & Wellness: Stress, Anxiety & Healthy Relationships Public Policy & Civic Engagement Science, Medical & Health Visual Arts This field is hidden when viewing the formPlease select your 2nd choice of mentor topic.* Engineering, Architecture, and Construction Entertainment Game Development, App Development & Technology General - Women in Business Health & Beauty Mental Health & Wellness: Stress, Anxiety & Healthy Relationships Public Policy & Civic Engagement Science, Medical & Health Visual Arts This field is hidden when viewing the formPlease select which session you’re available. If you’re available for both sessions, select both.* Select All Group A: October 11, 18, 25 and November 1 Group B: October 13, 20, 27 and November 3 This field is hidden when viewing the formInterested in different topics? Please add your suggestions below.Terms of Submission*Please note, by completing this form you are opting into the Emerging Leaders network. You are NOT registered for the Mentorship and Career Exploration program. Information on registering for the Mentorship and Career Exploration program will be emailed to you in August. I understand the terms of submission. CAPTCHA
