On My Own Teen Interest Project Patch Report

Troop #_____
Troop Advisor Use Only
Name____________________________________
Number of Activities Completed: ______
Name of IPP _____________________________ Each Activity Sufficiently Completed: ______
If not, what activity (ies) need(s) work? ______
IP Found on Page(s)_________ of IP Book or Online (circle) Scout was prepared to share work: ______
Date Scout demonstrated her work: ____________
MUST COMPLETE 6 ACTIVITIES PER IPP Scout met all requirements to earn this IPP: ______
This IPP counts toward another award: ______
(Be prepared to share your badge work with the troop.)
If so, which one? _____________
Each activity must be initialed the adult supervising the activity Date IPP Awarded: ______________
Advisor Approval/Signature ______________________
Activities completed:

1. (Build: Required Activity Or Skill Builder # ) __________________________________________

Dates activity was begun __________________and finished: __________________ Supervising Adult Initial______
This is what I did:

2. (Learn: Or Skill Builder # ) __________________________________________

Dates activity was begun __________________and finished: __________________ Supervising Adult Initial______
This is what I did:

3. (Do: or ___________ # ) __________________________________________

(Can be from any category other than the one the “Share” activity is from)
Dates activity was begun __________________and finished: __________________ Supervising Adult Initial______
This is what I did:

4. (Share: or ___________ # ) __________________________________________

(Can be from any category other than the one the “Do” activity is from)
Dates activity was begun __________________and finished: __________________ Supervising Adult Initial______
This is what I did:
5. (Design Your Own SMART Goal) __________________________________________
(SMART Goal is Specific, Measurable, Attainable, Realistic, Timely)
Use your imagination and interest to guide you in designing an activity related to the IP topic. This can be something you design totally on
your own or adapt an activity you find in other sources. Your goal should meet Safety-Wise and Council Guidelines.
o Write out the goal for Your Own activity, considering the following:
o What interest you most about the topic?
o What would you like to learn, do, and share?
o What do you hope to accomplish?
o What do you hope to gain from the experience?
o How will you measure your success?
List the steps you will take to achieve this goal. (Attach a separate sheet of paper if necessary.)
Dates activity was begun __________________and finished: __________________ Supervising Adult Initial______
This is what I did (list goals set, how they were met, and what you gained from your experience):

6. (Reflect) ___________________________________________________________
The activities for this Interest Project fit under what parts of the Girl Scout Promise and Law?
What skills or understanding have you gained to help you apply the Girl Scout Promise and Law to your life? Prepare a short reflection that
best expresses your experiences and personality, such as:
o 1-2 paragraph description o Short movie, video, or skit
o Poem o Thank you note to someone who helped
o Song/rap o Poster for your room
o Drawing/painting/photograph o Your own creative idea

Dates activity was begun __________________and finished: __________________ Supervising Adult Initial______
This is what I did:

Does completing this IPP meet a requirement for another Teen Girl Scout Award?
Choose only one, if applicable
Girl Scout Silver Award:
#2: Girl Scout Silver Leadership Award ( __ /3) #3: Girl Scout Silver Career Award _____
#4: Girl Scout Silver 4Bs Challenge ( Become Belong Believe Build )
Girl Scout Gold Award:
#2: Girl Scout Gold Leadership Award ( __ /3) #3: Girl Scout Gold Career Award _____
#4: Girl Scout Gold 4Bs Challenge ( Become Belong Believe Build )

Girl Scout: I have finished the requirements for this badge. Supervising Adult: Scout has finished the requirements for this badge.

_______________________________________________ _______________________________________________
Signature Date Signature Date

After completion, turn this form into your advisor for recording accomplishments.