GIRL SCOUTS OF THE PHILIPPINES

National Headquarters
Manila

CGSMS Form No. 1

CHIEF GIRL SCOUT MEDAL SCHEME

APPLICATION FORM

I. Personal Information
Name : Jericha Dale Vera Cruz Rosales
Address : Villa Alegre, Brgy. Tugas, Tanjay City, Neg. Or.
Telephone No. : 09362017269 Troop No.: 1506
Region : Visayas Council: Negros Oriental-Siquijor
Troop Leader : Ms. Niña Mae M. Cañolas
Parents : Roberto B. Rosales Jr.; Delia V. Rosales
Occupation : Therapist; Housewife
Registration Dates : July 9, 2016; June 16, 2017
Three (3) Years of Girl Scouting Experience
3 years- Star Scout
3 years- Junior Scout
3 years- Senior Scout

II. Badgework (2 badges for each of the 8-Point Challenge)

Badges Earned Challenge Dates Earned

1. Personal Safety Preparedness August 28, 2016
2. Public Safety -do- -do-
3. Recycling Environment September 2, 2016
4. Ecologist -do- -do-
5. Relating with Other Well-being September 16, 2016
6. Friendship Badge -do- -do-
7. Links of Unity World Community September 17, 2016
8. Harmony in Diversity -do- September 16, 2016
9. Food Production Economic Self-suff. July 7, 2016
10. Money Management -do- -do-
11. Performing Arts Arts September 17, 2016
12. Handicrafts -do- September 3, 2016
13. Me and my Family Family Life September 23, 2016
14. Family Outreach -do- September 24, 2016
15. Community Service Heritage & Citizenship September 16, 2016
16. Costume & Traditions -do- September 17, 2016
III. Camping Record Encampment Date Place
Troop : School Encampment Sept. 9-11, 2016 Tanjay City Science
High School
District : ____________________________ _______________ __________________
Council : 34th Council Junior, Senior, Sept. 22-25, 2016 Camp Lily I. Gamo,
& Cadet Encampment Sibulan, Neg. Or.
Regional: ____________________________ _______________ __________________
National: ____________________________ _______________ __________________
International: _________________________ _______________ __________________
IV. Chief Girl Scout Medal Orientation/Workshop
Date May 22, 2017 Place GSP Headquarters, Dumaguete City

Submitted by: JERICHA DALE V. ROSALES

Name of Candidate

Noted by: NIÑA MAE M. CAÑOLAS

Troop Leader

RAZZIL P. NOCETE
Council Executive

AIDA C. SAROMINES
Regional Executive Director

Attachments:
1. Troop Leader’s Endorsements
2. Parent’s Endorsements
3. Community Profile

Due EO August