Girl Scouts of the Northwestern Great Lakes Funding Survey 2010-11Girl Scouts of the Northwestern Great Lakes Funding Survey 2010-11

Thank you for helping Girl Scouts with this anonymous survey! It is not necessary for you to write any names on this survey. This survey will be collected from members throughout our entire Council for funding purposes. Grant and United Way funding is becoming increasingly competitive due to our economic environment. This information is critical for Girl Scouts to receive funding in order to continue delivering leadership programs for your daughter. We prefer to collect this information anonymously to protect your privacy. Please only complete this survey once per membership year.

1

County of Residence:

2

City of Residence

3

*Zip Code:

Zip Code:

4

Number of Girl Scout members in household:

Number of Girl Scout members in household: 1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

5

Total number of residents in household:

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

6

Is your child eligible to receive free or reduced lunch at school?

Is your child eligible to receive free or reduced lunch at school? Yes

No

7

Please choose your annual household income bracket:

Please choose your annual household income bracket: $0-$20,000

$20,001-$27,000

$27,001-$34,000

$34,001-$41,000

$41,001-$48,000

$48,001-$55,000

$55,001-$62,000

$62,001-$68,500

$68,501 or more