Request Gold Star Citation

Request a Gold Star Citation

Legislative citations are an opportunity for me to honor constituents in my district for their work in a variety of different capacities. Please fill out this form to request a legislative citation for yourself or someone else in our community who deserves recognition. Please provide as much detail as possible in order to help me honor the citation recipient.

Citation Requester's Information

First Name: *

Last Name: *

E-mail: *

Phone Number *

Home Address (Street, City, Zip) *

Citation Information

Date by which you need the citation *

How would you like the citation delivered? *

Mail
In-Person Presentation by Senator Agard

If you selected in-person delivery, please describe the date, time, location, and any other information about when the citation should be delivered.

If you selected mail, please provide the address you would like the citation sent to.

Information about Gold Star Citation Recipient

Name as you would like it displayed on citation *

Parent or Guardian Name *

Phone Number *

Email Address *

Troop/Group Number *

Council and Description *

Girl Scout Gold Award Project Advisor *

Girl Scout Gold Award Project Advisor Phone Number *

Number of Badges Earned *

Favorite Badge *

Senior/Ambassador Journey Books Participated In (list, please) *

Camps Attended (list, please) *

Girl Scouts Leadership Positions, Honors, Awards, and Activities of Note *

Date of Gold Star Ceremony *

Brief Description of Take Action Project *