ࡱ> '` pLbjbj{P{P |::kVVVVVVVj8*,jcCh(nhDpBBBBBBB$Dh3GbBuV(^((BVVC,,,(VVB,(B,,>VVr@ pB~I)N?B3C0cCb?G)G(r@GVr@,N"4$3BB*cC((((jjj NjjjNjjjVVVVVV Camp CEO is a wonderful opportunity for you to engage with up to 24 of Tennessees and Mississippis most accomplished top women CEOs and executives during a weekend at Girl Scout Kamp Kiwani. Youll get an inside look into the womens successful careers, including challenges they faced, choices they made, and skills they developed. You will participate in sessions that focus on public speaking, interview techniques, resume writing, money management and building leadership in addition to participating in fun recreational activities like canoeing, archery, karaoke, and tye dying. Applications are available at  HYPERLINK "http://www.girlscoutshs.org" www.girlscoutshs.org. WHO: Girls in grades 9-12 WHEN: July 30-August 1, 2010 10 a.m. Friday-2 p.m. Sunday WHERE: Girl Scout Kamp Kiwani Middleton, TN Transportation will be provided to and from the campsite COST: $25.00 Includes Girl Scout membership October 1, 2010-September 30, 2011 HOW: Complete the attached application and submit along with your high school transcript to the Girl Scouts Heart of the South Memphis Regional Service Center. Mailing Address: Girl Scouts Heart of the South Attention: Venus Chaney P.O. Box 240246 Memphis, TN 38124-0246 Street Address: 2715 Kirby Parkway, Suite 1 Memphis, TN 38124-0246 Fax: (901) 797-2183 Attention: Venus Chaney E-mail: Venus Chaney venus.chaney@girlscoutshs.org Applications are due no later than 5:00 p.m., Thursday, April 1, 2010. Do not submit payment with this application. Payment is due after notification of acceptance into the program. You will be notified via e-mail or phone of acceptance no later than April 16, 2010. Contact Venus Chaney at  HYPERLINK "mailto:venus.chaney@girlscoutshs.org" venus.chaney@girlscoutshs.org or by phone at 1-800-727-8104 for more information. Regional Service Centers Columbus, MS 662-328-1930(FAX: 662-328-1220(321 7th Street North, Columbus, MS 39701(Mailing: P. O. Box 2492, Columbus, MS 39704 Corinth, MS 662-287-8321(FAX: 662-286-8142(718 Taylor Street, Corinth, MS 38834( Mailing:P. O. Box 1145, Corinth, MS 38835 Grenada, MS 662-226-0255 or 888-453-2034(FAX: 662-226-0258(2430 Sunset Drive Ste D, Grenada, MS 38901 Jackson, TN 731-668-1122(FAX: 731-661-0011(1007 Old Humboldt Road, Jackson, TN 38305 Memphis, TN 901-767-1440 or 800-727-8104(FAX: 901-797-2183(2715 Kirby Pkwy, Ste 1, Mphs, TN 38119(Mailing: PO Box 240246, Memphis, TN 38124 Tupelo, MS 662-844-7577 or 800-624-4185(FAX: 662-680-3164(1800 W. Main St., Tupelo, MS 38801(Mailing: P.O. Box 1087, Tupelo, MS 38802 Website: www.girlscoutshs.org 1. Name  FORMTEXT       2. Permanent home address  FORMTEXT       City  FORMTEXT       State  FORMTEXT       Zip  FORMTEXT       3. Telephone number ( FORMTEXT      )  FORMTEXT       Cell number ( FORMTEXT      )  FORMTEXT       4. E-mail address (IF AVAILABLE)  FORMTEXT       5. School Name  FORMTEXT       Grade  FORMTEXT       6. School Address  FORMTEXT       7. T-shirt size (check one)  FORMCHECKBOX  Adult Small  FORMCHECKBOX  Adult Medium  FORMCHECKBOX  Adult Large  FORMCHECKBOX  Adult X Large  FORMCHECKBOX  Adult XX Large HIGH SCHOOL INFORMATION - To be completed by high school official (35%) 8. High school grade point average (on 4.0 scale or numerical grades, i.e., 90, 95, etc.) GPA:  FORMTEXT       9. I have included a copy of the student s current transcript with this application.  FORMCHECKBOX  Yes  FORMCHECKBOX  No 10. I certify that the above information is true and correct to the best of my knowledge as reflected by appropriate school records. Signature of school official  FORMTEXT       Date  FORMTEXT       LEADERSHIP l m  w | } ~ s  A D w }  گ~llll#hpZhpZ>*CJOJQJ^JaJhDVCJOJQJ^JaJ#hpZhpZ5CJOJQJ^JaJ h3hpZCJOJQJ^JaJ$hpZhpZ0JCJOJQJ^JaJ/jhpZhpZCJOJQJU^JaJ)jhpZhpZCJOJQJU^JaJ hpZhpZCJOJQJ^JaJ# + ; v w n q < ? 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On a separate sheet list high school, community and church activities, including all awards and positions of leadership held as well as membership in various student organizations. Print legibly in blue or black ink or type. Maximum of one page. Essay (30%) 12. On a separate sheet please describe why you want to participate in Camp CEO. Print legibly in blue or black ink or type. Maximum of one page. CERTIFICATION 13. I certify that the above information is true and correct to the best of my knowledge. Any misrepresentation will result in disqualification. Student  FORMTEXT       Date  FORMTEXT       Parent/Guardian  FORMTEXT       Date  FORMTEXT       AN INCOMPLETE APPLICATION WILL NOT BE CONSIDERE@@@@AAAAAAAqAAAAAAAABBBBBB޸|hY?2j~ hha>*CJOJQJU^JaJh>*CJOJQJ^JaJ&jh>*CJOJQJU^JaJh3CJOJQJ^JaJ h3h3CJOJQJ^JaJhpZCJOJQJ^JaJh35CJOJQJ^JaJ&hpZhpZ5>*CJOJQJ^JaJ#hpZhpZ5CJOJQJ^JaJ h3hpZCJOJQJ^JaJ hpZhpZCJOJQJ^JaJBBBBBBBB C CCCCCC CBCDCXCZC\CfChCjCrCtCvCCĶĜĊy_Ķ2jj hha>*CJOJQJU^JaJ hpZhpZCJOJQJ^JaJ#h3hpZ>*CJOJQJ^JaJ2j hha>*CJOJQJU^JaJh3CJOJQJ^JaJh>*CJOJQJ^JaJ1jh>*CJOJQJU^JaJmHnHu&jh>*CJOJQJU^JaJCCCCCCCCCCCDLLLLҹҪygSgQg@/ hkzhgUbCJOJQJ^JaJ hpZhpZCJOJQJ^JaJU&hpZhpZ5>*CJOJQJ^JaJ#hpZhpZ5CJOJQJ^JaJ h3h3CJOJQJ^JaJhpZCJOJQJ^JaJ#h3hpZ>*CJOJQJ^JaJh>*CJOJQJ^JaJ1jh>*CJOJQJU^JaJmHnHu&jh>*CJOJQJU^JaJ2j hha>*CJOJQJU^JaJD.     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