Request for Girl Scout Member Years of Service

Volunteer Award Coordinator Information

This can also be the Service Unit Manager's information or another representative's information - must approved by the Service Unit Manager
Name of person requesting pins*

First NameLast Name
Service Unit*
Phone Number of requester*
Email of requester*
example@example.com
Address of requester*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I understand if the Service Unit Manager, Volunteer Award Coordinator or other designated SU Volunteer is not able to pick up the pins of absent awardees at the ceremony, awardee materials will be given to the Community Manager or mailed to the address listed on this form.*

I understand
For those who are not in attendance of the Volunteer Awards Ceremony I would like to...

Pick up my pins at the Volunteer Awards Ceremony/Volunteer Leadership RallyReceive my pins from my Community ManagerPick up my pins at the Leadership Center in Tampa

5 Years of Service Recognition

Although volunteers with 5 years of service are recognized at the Service Unit Level, they will still be recognized in the volunteer awards program book.
Volunteers with 5 years of service are recognized at the service unit level. Pins are purchased by the service unit and should be presented at a SU Volunteer Appreciation event or end of year celebration event.

Link to purchase 5 years of service pins
Names of Volunteers Receiving 5 Year Pins (one name per line) If you have no volunteers receiving 5 year pins, skip this page.
Please make every effort to spell each name correctly
I understand that 5 years of service pins are not purchased or distributed by council. Service units can purchase 5 years of service pins through the Girl Scout store using the link above.

I understand

Missing or Replacement Awards/Recognitions

This section is intended to report any formal awards or recognitions (Years of Service and Numeral Guard) that were not received by a volunteer in your Service Unit or for lost/broken awards.
Do you have a volunteer who needs to replace/receive a pin?

Yes, I have a volunteer who needs a Years of Service Pin (+10 years only)Yes, I have a volunteer who needs a Numeral Guard Pin (+30 years only)Yes, I have a volunteer who needs a formal award (must be an award we currently offer)No, I don't have any volunteers who need to receive/replace a pin
Please list the volunteer's name AND which pin they need (please be specific):
Should be Empty:

Volunteer Award Coordinator Information