Association Number Service Unit Number Troop Number Program Level. Birth Date Age Grade Class of

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1 Silver Trefoil Report Form This form is used to document the final report of the Silver Trefoil. Please submit this final report after completing all requirements. This report must be submitted to the Teen Program Specialist by March 15 th for the girl to be recognized at the s recognition ceremony that spring. Please type or print legibly in black ink. FORM SUBMISSION Mail: Girl Scouts Nation s Capital ATTN: Teen Program Specialist 4301 Connecticut Avenue NW, Suite M-2 Washington, DC silvertrefoil@gscnc.org SILVER TREFOIL REPORT (DEADLINE IS MARCH 15 th ) Association Number Service Unit Number Troop Number Program Level Applicant s Name Girl Scout Identification Number Address City State Zip Phone Birth Date Age Grade Class of Dates as Cadette Hours Earned as Dates as Senior or Cadette Ambassador - - Hours Earned as Senior or Ambassador My personal goals and reasons for earning this award are: I have reevaluated this goal as I bridged to the Senior level. I have reevaluated this goal as I bridged to the Ambassador level.

2 Girl Scout Community Hours minimum of 50 hours The Girl Scout Law asks us to be a sister to every Girl Scout. To earn the Silver Trefoil Award, embody the Girl Scout law. 1. Service Hours minimum of 15 hours Volunteer at the council level, in order to provide service that has an impact on the whole council. 2. Service Unit/Association/Troop hours minimum of 25 Volunteer at the service unit/association level, in order to provide service that has an impact on your local Girl Scout community. GIRL SCOUT COMMUNITY SERVICE CATEGORY (COUNCIL & SERVICE UNIT/ASSOCIATION/TROOP HOURS) Month/Year of Service Number of Hours Brief Explanation of Service Subcategory Total Hours Total Hours Total Girl Scout Community Hours

3 Girl Scout Community Hours Questions What did you learn about the Girl Scout Community through your service in this category? The Girl Scout Law asks us to be a sister to every Girl Scout. How did you accomplish this through your service in this category?

4 National Service Hours Minimum of 25 hours This category has been redefined as national service hours, with the understanding that government remains a partial requirement. Service to country and community is part of the Girl Scout tradition. 1. Hours Minimum of 10 hours Provide non-partisan service to federal, state or local government entities. This may include nongovernment entities that fulfill a governmental role such as the Kennedy Center, Smithsonian or Post Office. 2. Hours Minimum of 5 hours Service that fulfills a need in close proximity to your home, your school or your troop; either in your town or your county. 3. Hours Minimum of 5 hours Service that helps protect the environment. NATIONAL SERVICE CATEGORY (GOVERNMENT, LOCAL, & GREEN HOURS) Month/Year of Service Number of Hours Brief Explanation of Service Subcategory Total Hours Total Hours Total Hours Total National Service Hours

5 National Service Hours Questions What did you learn about national needs through your service in this category? The Girl Scout Law asks us to respect authority, respect myself and others, and use resources wisely. How did you accomplish this through your service in this category?

6 Global Service Hours Minimum of 25 Hours In light of our s expansion and to reflect the guiding principle of the Girl Scout Mission Statement: Girl Scouting builds girls of courage, confidence and character who make the world a better place, the Silver Trefoil Award requires Global Service hours. Global Service hours encompass service to international communities and multicultural service. 1. Hours Minimum of 10 Hours Service that has a direct impact on the global community, whether local or in another country. 2. Hours Minimum of 10 hours Make the world a better place where all social and ethnic groups interact with tolerance and understanding. GLOBAL SERVICE CATEGORY (INTERNATIONAL & MULTICULTURAL HOURS) Month/Year of Service Number of Hours Brief Explanation of Service Subcategory Total Hours Total Hours Total Global Service Hours

7 Global Service Hours Questions What did you learn about the Global Community through your service in this category? The Girl Scout Law asks us to make the world a better place. How did you accomplish this through your service in this category?

8 Service Reflection What was your most meaningful service experience? Why? Signature of Silver Trefoil Recipient: Date: Signature of Teen Advisor (Troop Advisor): Date: Date sent to Girl Scouts Nation s Capital: I have kept a copy for my records