Special Event/Money Earning Application SEME Application Start Event Start Date * If you are not using the calendar enter you date MM/DD/YYYY. Event Stop Date * If you are not using the calendar enter you date MM/DD/YYYY Event Name * Event Description * For information on the types of events your troop can facilitate please consult the Special Events/Troop Money Earning Guide Event Hosted By * Troop Service Unit Individual or Speciality Group Troop # * Region * North Southeast Southwest For an Individual or Specialty Group select the Region the submitter is from Service Unit * For an Individual or Specialty Group please select the Application Submitter's Service Unit. If the Submitter is also the Service Unit approver for Special Events please provide an alternate email in the "Comments" field at the bottom of this form. Host Troop Program Level * Brownie Junior Cadette Senior Ambassador * For multi - level, select all applicable program levels. Leader's information Name * Name of Troop Leader Phone # * Email * Event Information Is This a Recruitment Event ? Yes No Is This a Money Earning Event ? * Yes No If a fee is being charged for the event then "Yes" needs to be selected. Break Even Event? * Yes No Click Yes if you do not expect to make money on this event, otherwise click No if you do expect to make money. Event is open to * Service Unit Region Council Wide Community Select The Focus Area(s) Addressed * Arts & Culture Business Smarts & Leadership Enviroment and Outdoor Adventure STEM (Science, Technology, Engineering and Math) Wellness and Healthy Living Event Location Name * Site Phone # * Street Address * City * State * Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP Code * Closest Emergency Hospital * Adult Event Director Name * Name of the Event Director Phone * Email * Event Director Has Been Trained * Yes No Special Event/Troop Money Earning Training Date * Explaination for training delay * Explain why the Special Event/Money Earning Training has not been taken and below state by what date you expect to be trainned. Date Training will be completed by * Adult Co/Assistant Event Director Name * Name of Adult Co/Assistant Event Director Phone * Email * Special Event/Troop Money Earning Training Date Troop Event Financial Manager/Adult Name * Phone * Email * Girl Troop Event Director Name Phone Email Volunteers Adult Volunteers * There needs to be a minimum of 2 adults to run an event. Junior Aides * Program Aides * Leader in Training * Counselor in Training * Total * Off-Site Emergency Contact Name * Phone * Alternate Phone * Email * Anticipated Number of Participants Please enter the number of people who are hoping will be attending your event by Girl Scout Level. Daisy * Brownie * Junior * Cadette * Senior * Ambassador * Non-Scouts * Adults * Number of Expected Customers * Total # * Briefly describe girl involvement in the planning process First Aider A first aider must be provided for every 200 people in attendance. The form provides space for 2 people however, if you have more please add them in the comment section. Name * If this for an individual girl who is not doing a special event please enter "Not Applicable" Phone * Email * If this is for an individual girl not running a special event enter the submitter's email address Medical Professional? * Yes No Click yes if the first is a Medical Professional. Otherwise click no. Title * If Medical Professional please provide your title (Nurse, Doctor, EMT etc...) CPR Expiration Date * First Aid Expiration Date * Wilderness and Remote First Aid Training Expiration Date Require if EMS can not reach event site in less than 30 minutes. Second First Aider for next 200 attendees Name * Phone Number * Email Address * Medical Professional? * Yes No Title * CPR Expiration Date * First Aid Expiration Date * Wilderness First Aid Training Expiration Date Require if hospital is more than 30 minutes from event site Additional First Aiders * Please add the names of additional First Aiders here if over 400 Additional Event Requirements Will there be swimming? * Yes No Is Swimming available at your event? Lifeguard? * Supplied by Facility Supplied by event organizer Lifeguard's Name * Name of Lifeguard Lifeguard's Email Address Lifeguard Cert. Expiration Date * Lifeguard's certification Expiration Date Is additional insurance required for this event? * Yes No Please note * If non scouts are attending the event additional insurance is required. Date Insurance will be obtained by * Does location require a signed contract? * Yes No If yes, please consult Volunteer Essentials for guidelines Upload Contract Uploading Files. Please Wait. File must have one of the following extensions: pdf, zip, doc, or docx However, the jpeg or giff format is too pixilated to get a good image. If you do not have access to scanner you can go to your nearest service center and have a staff person scan the contract and then send the attachment to you. This can then be attached to your application. Does location requre a Certificate of Insurance (COI)? * Yes No Event Flier Upload Event Flier * File must have one of the following extensions: jpg, pdf, zip, doc, docx, or txt Comments Flier Updated Yes No Do you want your event posted by Council? Yes No Event Start Time * 12:00 AM 12:30 AM 01:00 AM 01:30 AM 02:00 AM 02:30 AM 03:00 AM 03:30 AM 04:00 AM 04:30 AM 05:00 AM 05:30 AM 06:00 AM 06:30 AM 07:00 AM 07:30 AM 08:00 AM 08:30 AM 09:00 AM 09:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 01:00 PM 01:30 PM 02:00 PM 02:30 PM 03:00 PM 03:30 PM 04:00 PM 04:30 PM 05:00 PM 05:30 PM 06:00 PM 06:30 PM 07:00 PM 07:30 PM 08:00 PM 08:30 PM 09:00 PM 09:30 PM 10:00 PM 10:30 PM 11:00 PM 11:30 PM Enter the time your event will start. Event End Time * 12:00 AM 12:30 AM 01:00 AM 01:30 AM 02:00 AM 02:30 AM 03:00 AM 03:30 AM 04:00 AM 04:30 AM 05:00 AM 05:30 AM 06:00 AM 06:30 AM 07:00 AM 07:30 AM 08:00 AM 08:30 AM 09:00 AM 09:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 01:00 PM 01:30 PM 02:00 PM 02:30 PM 03:00 PM 03:30 PM 04:00 PM 04:30 PM 05:00 PM 05:30 PM 06:00 PM 06:30 PM 07:00 PM 07:30 PM 08:00 PM 08:30 PM 09:00 PM 09:30 PM 10:00 PM 10:30 PM 11:00 PM 11:30 PM Enter the time the event will be over. Event Open to the following Girl Scout Level Daisy Brownie Junior Cadette Senior Ambassador Price per Scout * Price per Non Scout * Price per Adult * Price includes: * Tagalongs okay? * Yes No Finances Type of Financial Report being provided * Troop's Current Annual Report Troop's Current Bank Statement Both the Bank Statement and the Annual report must be current to 30 days prior to application for event. The ending date on the financial must be no more that 30 days prior to the application date. Example: If you are applying for a Special Event in December you can not use your troop annual financial that you submitted to your Service Unit. However, you can update your annual financial to 30 days prior to your application if you choose. Upload Troop's Current Financial * *Troop must be in good financial standing. Also please blank out your troop bank account number on your financial before up loading your financial. File must have one of the following extensions: jpg, gif, bmp, tiff, pdf, zip, doc, docx, txt, wp, csv, xls or xlsx. Upload Troop's Current Bank Statement * *Troop must be in good financial standing. File must have one of the following extensions: jpg, gif, bmp, tiff, pdf, zip, doc, docx, txt, wp, csv, xls or xlsx. Troop has Participated in Both Cookie and Fall Product Sales in the Last 12 Months? * Yes No In order to conduct a money earning event the troop must have participated or plan to participate in both product sales in the current program year. Explain resaon for non-particpation in Product Sales * Current Balance in Service Unit Bank Account * Enter either a whole number or decimal value (i.e. 0 or 0.00) Total funds required for activity or trip that is your goal * This should be the amount that will be need for the trip or activity the money earning revenue is being put toward, not this activity. Enter either a whole number or decimal value (i.e. 0 or 0.00) Do not enter a $. Estimated Net Profit from this Event * Enter either a whole number or decimal value (i.e. 0 or 0.00) Do not enter a $ Current funds available for activity or trip * Enter the amount of money that you have already raised toward your goal activity. Enter either a whole number or decimal value (i.e. 0 or 0.00) Do not enter a $. Reason funds are needed * Are you Soliciting In-Kind Gifts Yes No Will you be Soliciting Sponsorships? Yes No Comments Almost Done Name * Name of person submitting this application Submitter's Email * Contact information if problem with this application. Signature of Leader * Yes By submitting this form, I agree that the above and below statements are true, that I have read and agree to adhere to the GSUSA and GSGLA policies regarding troop money earning activities and safety as stated in Volunteer Essentials and GSUSA Safety Guidelines, and this application. I have reviewed the Policies concerning troop money earning and agree to adhere to them. I have reviewed this form and understand my (our) responsibilities. I am aware that Girl Scouts must be supervised by two registered adult at all times. Submission Notes Submitter's Comments Print application before submittal, in case the server goes down. If you are experiencing problems in getting your application submitted and you are using Internet Explorer as your browser please switch over to Chrome., Firefox or Safari. If you continue to have problems please try later in the day. Sometimes we have been experiencing problems with the server. These are temporary. You should receive a confirmation email in 5 to 10 minutes. If you do not receive an email. Please check your email spam for a message from seme@girlscoutsla.org. If you do not receive an email please contact us directly at seme@girlscoutsla.org. Also, we have been experiencing an issue with yahoo mail provider. If you are the submitter and have an alternate email for your yahoo account please use that one. 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