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Gold Award Take Action Project Proposal

Submit to: Girl Scouts of Greater New York Leadership Center


40 Wall St. Suite 708, New York, NY 10005
Or email it to goldawardproject@girlscoutsnyc.org

THIS FORM MUST BE SUBMITTED TO COUNCIL AND APPROVED BEFORE THE START OF YOUR TAKE
ACTION PROJECT. PLEASE KEEP A COPY OF THIS FOR YOUR RECORDS.

PERSONAL DATA PLEASE PRINT CLEARLY AND COMPLETE THE ENTIRE FORM- Be sure to use an
ACTIVE email address. We need to be able to reach you via email.

Girls Name: Phone #: ( )

Girls E-mail address:

Address: Todays Date

Apt. # City: Zip:

Age: DOB: Grade: School Name:

Troop/Group #: Meeting Place: ______________________________________________________

Senior/Ambassador GS since mo/yr: / Expected H.S. Graduation mo/yr: ______/ ___

Name of Leader:

Leaders E-mail address:

Leaders Phone # (Day): ( ) Leaders Phone # (Eve): ( )

Leaders Address: Apt. #:

City: Zip:

Name of Advisor/Mentor: __

[If Project Advisor or Mentor is different than The Troop Leader]

Mentors E-mail address: _____________

Mentorss Phone # (Day): ( ) Mentors Phone # (Eve): ( )

Name of Parent/Guardian:

Parent/Guardians E-mail address:

Parent/Guardians Phone # (Cell): ( )

Parent/Guardians Address: Apt. #:

City: Zip:
Gold Award Take Action Project Proposal
Submit to: Girl Scouts of Greater New York Leadership Center
40 Wall St. Suite 708, New York, NY 10005
Or email it to goldawardproject@girlscoutsnyc.org

PREREQUISITES

Please provide the two Senior or Ambassador Journeys or one Journey and the Girl Scout Silver Award which
you earned. Be sure that your leader signs here, or your project will be sent back for revision.

Senior Ambassador Journey Books or Date Completed Troop/Group Volunteers


Silver Award (Month/Year) Signature

If you earned your Silver Award please let us know the year _______ and the council:

Girl Scout Council of ___________________________________________.

YOUR TEAM

List the names of the individuals and organizations that you plan to work with on your Take Action Project. This is
a preliminary list that may grow through the course of your project.

Team Member Affiliation Role


Gold Award Take Action Project Proposal
Submit to: Girl Scouts of Greater New York Leadership Center
40 Wall St. Suite 708, New York, NY 10005
Or email it to goldawardproject@girlscoutsnyc.org

YOUR TAKE ACTION PROJECT PROPOSAL

Project Title: _______________________________________________________________

Proposed Start Date: ___________ Proposed Completion Date: ______________

Please type up the answers to the following questions and attach to form.

A. Describe the issue your project will address and who is your target audience.
B. Discuss your reasons for selecting this project.
C. Outline the strengths, talents, and skills that you plan to put into action. What skills do you hope to
develop?
D. Describe the steps involved in putting your plan into action, including resources, facilities, equipment, and
approvals needed. This should be very detailed and include the following:
The names of people or organizations you plan to inform or involve.
Estimate overall project expenses and how you plan to meet these costs. Remember that you
cannot raise money for another organization and you can not solicit funds. However, you can
solicit things. You can also use a small amount of your own money, but it should not be
excessive.
What methods or tools will you use to evaluate the impact of your project? Consult the impact
planning below.
How will your project be sustained beyond your involvement?
E. What impact will your project have on your community? The following is a list of the 15 Girl Scout
Leadership Outcomes. Which do you think YOU will personally develop through this project. Check off all
that apply.
Discover
I will develop a stronger sense of self.
I will develop positive values.
I will gain practical life skills.
I will seek challenges in the world.
I will develop critical thinking.

Connect
I will develop healthy relationships.
I will promote cooperation and team building.
I will resolve conflicts.
I will advance diversity in a multicultural world.
I will feel more connected to my community, locally and globally.

Take Action
I will identify community issues.
I will be a resourceful problem solver.
I will advocate for myself and others, locally and globally.
I will educate and inspire others to act.
I will feel more empowered to make a difference in the world.
Gold Award Take Action Project Proposal
Submit to: Girl Scouts of Greater New York Leadership Center
40 Wall St. Suite 708, New York, NY 10005
Or email it to goldawardproject@girlscoutsnyc.org

Using the impact planning chart below, please describe the impact you hope your project will have on your
community, your target audiences and you. Type out your answers on a separate page.

Impact on Goals Potential Impact

Your Community What community issue do you plan to What examples of the project impact
address? might you see in the future?

Target Audience (workshop What skills, knowledge, or attitudes will How will you know that the target
participants, other your target audience gain? audience gained skills or knowledge?
youth, community members
and so on)

Complete this form in its entirety. Then please send it to: Girl Scouts of Greater New York Leadership
Center, 40 Wall St. Suite 708, New York, NY 10005. Or kdenzer-weiler@girlscoutsnyc.org
The committee will then review it and you will receive a reply within 3 weeks.

Please remember to keep a copy for your records.

Your Signature: __________________________________________________ Date: __________________