Cookie Credits, Fall FUNds, and Juliette Program Credit Reimbursement Form Complete this form to be reimbursed for Cookie Credits, Fall FUNds, and Juliette Program Credits used to help pay for event fees associated with: Council-approved volunteer-led day camp Service unit-sponsored encampments Council-approved extended troop trips for Girl Scout Juniors, Cadettes, Seniors, and Ambassadors Girl Scouts of the USA Destinations travel Approved and completed Girl Scout Bronze, Silver, and Gold Award projects Juliette Girl Scout activities Questions? Contact usPlease Note: No expired credits will be eligible for reimbursement. Cookie Credits and Fall FUNds expiration dates extend for two additional years if used for extended trip travel only. Make sure to keep copies of the form and receipts for your records. Type of ReimbursementSelect one: Council-Approved Volunteer-Led Day Camp/Service Unit-Sponsored Encampment Highest Award (Bronze, Silver, Gold Award) Projects Juliette Program Activities Extended Troop/Juliette Trip, GSUSA Destinations Travel, or Council-Led Travel For Council Approved Volunteer-Led Day Camp/Service Unit-Sponsored Encampment Girl Scouts River Valleys recommends completing this form for program credits on a weekly basis to ensure funds are available. Paper Juliette Program Credits can be collected and submitted for reimbursement all at one time.General InformationName of Requestor* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email Address* The email address entered will be emailed a copy of the form upon submission.Phone Number*Girl Scout Name* First Last Girl Scout Name Select the (+) icon to add additional girls from your troop.Troop or Juliette Number* Service Unit Name or Number (Optional) To look up your service unit name or number, see our service unit directory.Position/RoleTroop LeaderDay Camp DirectorDay Camp Finance ManagerService Unit ManagerService Unit TreasurerJuliette MentorTrip LeaderParentOtherSince you selected "Other" enter your position/role in the space below.* Reimbursement InformationEvent/Project/Travel Name* Event/Travel Location* Event/Travel Dates* Do you want to convert paper or Electronic Juliette Program Credits to your Juliette Program Credits card?* Yes No Are you a graduating Juliette?* Yes No Graduating Juliette requesting remaining funds be donated to:* Girl Scouts River Valleys’ Family Giving Fund in support of general council operations. Girl Scouts River Valleys’ Troop Girl Scouts River Valleys’ Service Unit Non-profit charity whose mission is in line with Girl Scout Values Are you a Juliette Girl Scout transferring to a troop?* Yes No If yes, are you transfering your remaining Juliette Program Credits to your new troop?* Yes No Enter the Receiving Troop Number* I understand that my Juliette Program Credits will be transferred to the troop account and will be used to benefit the whole troop.* Yes, I understand Enter the Receiving Service Unit Name or Number* Is this for a Girl Scout activity?* Yes No Has a Travel Request Form been approved for this trip?* Yes No The Travel Request Form is available at Volunteers.GirlScoutsRV.org/Travel-RequestApproval Date of Travel Request Form MM slash DD slash YYYY Please provide an explanation/description of what the reimbursement request is being submitted for and a list of itemized expenses:*Please provide an explanation/description of what the reimbursement request is being submitted for and a list of itemized expenses:Amount of Receipt(s) Submitted:*This amount must equal or exceed amount of credits submitted.Amount of Receipt(s) Submitted:This amount must equal or exceed amount of credits submitted.Select the type of program credit you are submitting for Council-Approved Volunteer-Led Day Camp/Service Unit-Sponsored Encampment reimbursement.* Cookie Credits, Fall FUNds, or Juliette Program Credits Happy Camper Coupon (For Day Camp reimbursements only) Paper: Juliette Program Credits Select the type of program credit you are submitting for Highest Award (Bronze, Silver, Gold Award) Project(s) reimbursement.* Cookie Credits, Fall FUNds, or Juliette Program Credits Paper: Juliette Program Credits Select the type of program credit you are submitting for Juliette Program Activities reimbursement.* Cookie Credits, Fall FUNds, or Juliette Program Credits Paper: Juliette Program Credits Select the type of program credit you are submitting for Extended Troop/Juliette Trip, GSUSA Destinations Travel, or Council-Led Travel reimbursement.* Cookie Credits, Fall FUNds, or Juliette Program Credits Paper: Cookie Credits, Fall FUNds, or Juliette Program Credits Please complete or upload the information for each Girl Scout that submitted their program credits:*Girl Scout First NameGirl Scout Last Name19-digit card numberAmount of credits Select the (+) icon to add another row. Include the 19 digits of card number. Please complete or upload the information for each Girl Scout that submitted their coupon:*Girl Scout First NameGirl Scout Last NameCamp coupon code numberAmount of coupon to be used Select the (+) icon to add another row. Include the 19 digits of card number. Upload a report with coupon and/or program credit card information for each Girl Scout that submitted their program credits.Accepted file types: pdf, doc, docx, xls, xlsx, csv, txt, zip, jpg, jpeg, png, Max. file size: 50 MB.Please select the year of the paper credit you will be mailing:*(Select all that apply) 2019 Fall FUNds (expire Sep. 15, 2023 for approved troop trips) 2019 Cookie Credits (expire Sep. 15, 2023 for approved troop trips) 2020 Cookie Credits (expire Sep. 15, 2024 for approved troop trips) 2019 Fall FUNds Dollar Amount*2019 Cookie Credits Dollar Amount*2020 Cookie Credits Dollar Amount*Juliette Program Credits Amount Submitted*I understand that I will not receive a reimbursement until my paper program credits are received by Girl Scouts River Valleys.* Yes, I understand. Print the PDF copy of the completed reimbursement form attached to your email confirmation and mail along with the paper credits and receipts (if required) to: Girl Scouts River Valleys Attn: Reimbursement Form, 400 Robert Street South St. Paul, MN 55107Select which account to reimburse:*Please note: All Automated Clearing House (ACH) processing can take up to four weeks. Day Camp Account Automated Clearing House (ACH) (Please allow four weeks for processing) Service Unit Account Automated Clearing House (ACH) (Please allow four weeks for processing) Troop Account Automated Clearing House (ACH) (Please allow four weeks for processing) Travel Organization Check (Please allow four weeks for processing) Parent/Guardian Reimbursement Option: Non-Profit Charity (For graduating Juliette only; Please allow up to four weeks for processing.) Last four digits of day camp bank account number.* This bank account can only be reimbursement for Volunteer-led Day Camps.Last four digits of service unit bank account number.* This bank account can only be reimbursement for Service Unit Encampments.Last four digits of troop bank account number.* This bank account can only be reimbursement for extended travel, Highest Awards projects, and Juliette-to-troop transfers. If you are unsure of the troop number please enter n/a.Travel Organization Name* (Please allow up to four weeks for processing)Non-Profit Charity Name* (Please allow up to four weeks for processing)Travel Organization Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Account Number with Travel Organization* This will be included on the check for Travel Organization to know who to credit money.Name on Account with Travel Organization* This will be included on the check for Travel Organization to know who to credit money.Non-Profit Charity Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Select a preferred payment option for parent/guardian reimbursement: Check made payable to "Parent/Guardian" of "GIRL NAME" and mailed to address provided. (Please allow up to four weeks for processing) Automated Clearing House (ACH) (Please allow four weeks for processing) Emailed Address* To contact for collecting account information.Parent/guardian mailing address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supporting Documents* Drop files here or Select files Accepted file types: doc, docx, jpg, jpeg, png, pdf, xls, csv, Max. file size: 40 MB. Please upload receipts, etc. For troop travel, please attach your completed Travel Request Form. This amount must equal or exceed the amount of credits submitted. (Accepted file types are: doc, docx, jpg, jpeg, png, pdf, xls, csv)Supporting Documents Drop files here or Select files Accepted file types: doc, docx, jpg, jpeg, png, pdf, xls, csv, Max. file size: 40 MB. Please upload receipts, etc. For troop travel, please attach your completed Travel Request Form. This amount must equal or exceed the amount of credits submitted. (Accepted file types are: doc, docx, jpg, jpeg, png, pdf, xls, csv) Δ