Special Event/Money Earning Application SEME Application If you are human, leave this field blank. 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 or other adult in charge Phone # * Email * Event Information Is This a Recruitment Event ? Yes No Is This a Money Earning Event ? * Yes No If any money is being collected/charged, then “Yes” needs to be selected for the event. Break Even Event? * Yes No Click “Yes” if you do not expect to make a profit on this event, otherwise click “No”. If your event is earning money that will be fully donated or used for a service project please still click “No”, as the troop is initially profiting from the event. Event is open to * Service Unit - Only your immediate service unit is invited to attend. Region - This event is open to service units and troops in your region. Council Wide - This event is open to any troop in the council to attend. Please note that this is the ONLY way you will get the ability to have your event posted to the event calendar on the GSGLA website. Community - This is for events where the majority of attendees are not Girl Scout troops. (ie. restaurant nights, yard sales, bake sales, etc.) Select The Focus Area(s) Addressed * Outdoors, Adventure, Camping Entrepreneurship, Leadership, Cookies Life Skills, Health and Wellness STE(A)M (Science, Technology, Engineering, Art, Math) Girl Scout Traditions (e.g. World Thinking Day) Journey, Badge Workshops Community Service OtherOther 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 Is the Adult Event Director the same as the Troop Leader? * Yes No 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 Are you working on either of the following? Girl Scout Silver Award Project Girl Scout Gold Award Project Neither 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 * Briefly describe girl involvement in the planning process Off-Site Emergency Contact Name * Phone * Alternate Phone * Email * *This contact should be the same person that is going to be listed on your event flier as the day of, off site, event emergency contact. This person should also not be in attendance at the event. 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. Anticipated Number of Participants Please enter the estimated number of people you are anticipating to have at your event. You will now report out on the number attended from each level on the Final Report. Registered Girl Scout Girls * Non-Registered Children/Adults * Registered Girl Scout Adults * Total # * Please mark each program level that will be invited or could attend this event Daisy Brownie Junior Cadette Senior Ambassador N/A (Community Event) 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 Does this event include/involve High Risk Activities? * Yes No Please provide the ET number (High Risk and Extended Travel Application) SEME Events cannot be approved until the High Risk Application has been submitted and approved. If an ET number is not available at this time, please email seme@girlscoutsla.org when you have the approved application number. 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 Click “Yes” if the location requires someone from council to sign the contract. If the leader or adult booking the location can sign it, the contract or receipt does not need to be submitted and “No” can be selected. If yes, please consult Volunteer Essentials for guidelines. Upload Contract Here * Uploading Files. Please Wait. Drop a file here or click to upload Choose File Maximum upload size: 67.11MB 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 Only events that are located at a venue that has formally requested a COI will receive a COI. The formal request can be a contract, email, letter, etc. from the location for a COI. The request must contain the event date(s), the name and address of whom the COI is to be issued to. Even if the event has occurred before at the same location, a formal request is required every year that the event is held and the COI is required. Please use this link https://www.gsglavolunteerapps.org/coirequest/ to submit your COI request for this event. Be sure to indicate that it is for a SEME. You will need to include the SEME number you receive upon submission of this form. Is this a Restaurant Event? * Yes No Do you plan to make more than $250 and/or does the restaurant require a tax receipt? * Yes No The donation needs to be made payable to “Girl Scouts of Greater Los Angeles, 801 S Grand Ave, Ste 300, Los Angeles, CA 90017. Please fill out and submit the Donation to Troop/Group/SU form here https://www.gsglavolunteerapps.org/donation/, and the money will be passed back to the benefiting troop/group/SU. See Volunteer Essentials for more information. The donation can be made out directly to the troop/group/SU, and sent to the appropriate person. Upload Troop/Group/Service Unit Restaurant Fundraiser Authorization Form Drop a file here or click to upload Choose File Maximum upload size: 67.11MB 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 * Drop a file here or click to upload Choose File Maximum upload size: 67.11MB *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 * Drop a file here or click to upload Choose File Maximum upload size: 67.11MB *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 achieved the product sale participation goals for both the fall and cookie sales goal during the previous 12 months. If this requirement has not been met, please explain why below and it will be reviewed individually. The participation goal is published in Volunteer Essentials for each 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 Event Flier Upload Event Flier * Drop a file here or click to upload Choose File Maximum upload size: 67.11MB File must have one of the following extensions: jpg, pdf, zip, doc, docx, or txt If you are having issues uploading your file, please check the following: - You are using Chrome, Safari, or Firefox on a laptop/desktop, and are NOT on a mobile device. - The file size doesn’t exceed the maximum limits. - If making multiple, failed, attempts to upload, clear your browsers cookies and cache and try again. - If you still receive an error message, upload a blank document, put the reasoning in the notes field below, and submit the actual flier via the Change Request Form, or via email to seme@girlscoutsla.org (be sure to include your SE number). Comments Flier Updated Yes No Do you want your event posted by Council? Yes No Event Start Time * 121234567891011 : 0030 AMPM Enter the time your event will start. Event End Time * 121234567891011 : 0030 AMPM Enter the time the event will be over. Event Open to the following Girl Scout Level Daisy Brownie Junior Cadette Senior Ambassador Price Per Girl Member * Price Per Adult Member * Price Per Non Member * Price includes: * Tagalongs okay? * Yes No Almost Done Name * Name of person submitting this application Submitter's Email * Contact information if problem with this application. Confirm Submitter's Email * Confirm Email This is the email address where all communication from the SEME process will be sent. Please ensure this is an email address checked regularly. If you are not receiving emails, check your SPAM folder. If there are not emails in your SPAM folder then please email SEME@girlscoutsla.org to verify the email on file. 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. Thank You. If you have any questions please email SEME@girlscoutsla.org. Be sure to include your SE number for reference and faster assistance. reCAPTCHA
