Dublin Coffman High School National Honor Society Application Packet General Guidelines

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1 General Guidelines 1. This application is our first interaction with you. Please remember your application is a direct reflection of your scholarship, leadership, service and character. Unorganized and incomplete forms as well as late excuses indicate your lack of the 4 NHS pillars. 2. All materials should be collected in 1 file folder - checklist, verification form, essays - and submitted by the student to Mrs. McGovern in the main office by the deadline of Thursday, October 19, 2017 at 3:00 pm. 3. All leadership, service and character verification forms should be collected by the candidate and put in a file folder. The required forms must come from different people for each category (3 different people for Leadership, 3 different people for Character. The same person could complete 1 Character and 1 Leadership form if they can explain your leadership qualities outside the classroom setting) All coaches of Coffman athletic teams are considered school sponsors (not community) even when the coach is not a teacher at Coffman High School. 4. Blank copies of each verification form are provided in this packet. Forms must be neatly completed with legible writing or typed. You can make copies as needed (library has copier) or print off extras from the NHS website. 5. Information on the forms should reflect a candidate s accomplishments in grades 9 through 12. This applies to service hours and all of the recommendation forms. Nothing from middle school should be submitted. 6. Juniors and Seniors applying in 2017 are required to demonstrate 20 hours of community service. No more than 5 of those hours can come from Coffman school organizations. All 20 can come from community organizations or 15 can be community service & 5 from Coffman service. Example: 5 hrs of FMP & 15 hours at Retirement Village 7. Generally speaking, service activities are those that are done for or on behalf of others in the community (not including immediate family members). NO compensation (monetary, class credit or other) cannot be received. Service MUST BENEFIT THE COMMUNITY. Important tips to remember about community service: ü If you got PAID, it does NOT count. ü If you re submitting 5 hrs of Coffman-related service: if you got school-related incentives such as missing a class, a grade, a class credit, hours/points in another club, etc; it does NOT count. (Ex: volunteering for Link program to show new students around school during 1 st period does NOT count because you missed class) ü If you re submitting 5 hrs of Coffman-related service: if it s during the school day is does NOT count. If it s before/after school or during the summer, it MAY count. (Ex- FMP meeting with Freshman during Homeroom does NOT count, FMP summer freshman orientation DOES count) ü If it s for personal or political gain, it does NOT count. ü If it s volunteering at for-profit business, it does NOT count (Ex volunteering in a Dr. office to file paperwork) ü If it s for a political partisan campaign it does NOT count. If it s for a non-partisan event, it DOES count. (Expassing out flyers door to door for a Democratic politician does NOT count. Registering 18 year olds to vote in a general election DOES count) 8. Service hours that are not verified or fulfilled completely will not be considered. You MUST give an explanation of how the service benefited the community. Service must be verified contact information must be given. It must be signed by an official, adult advisor/sponsor.

2 9. You may copy the Service Forms as needed (printer/copier in the library) or reprint forms from our website. 10. All Verification Forms are to be signed and dated by the adult advisor who completed the form. These forms need to be collected by the candidate. Do not have your teacher return it to NHS Advisors. Do NOT have excuses why they are not done. 11. All paperwork needs to be collected and neatly organized in 1 file folder and submitted to the main office by the specified deadline of Thursday, October 19, 2017 at 3:00 pm. Materials that are incomplete and/or submitted after the deadline WILL NOT be considered for membership. Any forms not completed and in the packet don t count. All materials must be submitted in a file folder clearly marked with the student s full name. If you are sick, get it here! You have plenty of time to complete the packet it s due on time! 12. This folder MUST be submitted in its entirety, including all Verification Forms, Obligations Signature Pages, Essays and all other documents listed in the Activity packet checklist to the main office by Thursday, October 19, 2017 at 3:00 pm. No exceptions! 13. Induction will be held Thursday, November 9, 2017 at 7:00 pm in the Dublin Coffman PAC. You must plan on attending and dressing professionally if you are inducted in to NHS. 14. If you have questions or concerns about the activity packet, please nhs@dublincoffman.com or speak with one of the advisors Mrs. D Souza in room 172 or Ms. Blackburn in room 107 Please remember your application is a direct reflection of your scholarship, leaderships, service and character. Please enclose all information listed below in the packet checklist and verification forms in 1 folder

3 Checklist This should be the top page in your packet. The following check sheet will assist a candidate in making sure that he/she has fulfilled all of the requirements for application. Submitting all of the necessary paperwork does not guarantee membership in the organization. Please include the checklist with your application packet. Submit all required materials ON TIME. Please assemble the application folder in the following order: SCHOLARSHIP: c Scholarship Obligations Signature Page LEADERSHIP: c 2 High School (teacher, coach, advisor) Leadership Verification Forms c 1 Community (employer, community sponsor) Leadership Verification Form CHARACTER: c 2 High School (teacher, coach, advisor) Character Verification Forms c 1 Community (employer, community sponsor) Character Verification Form SERVICE: c Service Verification Form(s) demonstrating an equivalent of 20 hours of community service. No more than 5 may be Coffman-related service (clubs, organizations, athletics, etc) ESSAY: c Completed an essay reflecting on leadership and character based on the assigned prompt Please remember your application is a direct reflection of your scholarship, leaderships, service and character.

4 Obligations Signature Page Congratulations! Because of your fine academic achievement, you are being considered for membership in the Dublin Coffman High School National Honor Society. By submitting your name as a candidate for membership, you are required to fulfill a number of requirements. Candidate s name: Cumm (Weighted) GPA. Grade level: If accepted in NHS, you agree to these statements by initialing each line: I agree to retain a 3.5 GPA or higher as an NHS member I agree to attend the NHS induction ceremony I agree to pay the initial dues at the induction ceremony I agree to attend monthly general NHS meetings I agree to all NHS graduation requirements for Club Activities and Service Hours I acknowledge that I am aware of the requirements to earn the privilege of being recognized at graduation as a member of NHS. To be accepted in NHS, you agree that these statements are true by initialing each line: I have read the Student High School handbook, including the Co-Curricular Activity Code. I have electronically signed the Student High School handbook, including the Co-Curricular Activity Code in the student dashboard (if not sure, please check with guidance or your student dashboard) I have not been involved in a documented incident of cheating at school for the time extending from my freshman year to the present. I have not been convicted of a crime or juvenile offense, other than minor traffic offenses, for the time extending from my freshman year to the present. I have not been disciplined with a Saturday School, In-School Detention, Out-of-School Suspension or Expulsion due to disrespect, insubordination, fighting, drinking or other offenses that violates the DCHS Code of Conduct for the time extending from my freshman year to present. If you would like us to consider extenuating circumstances, which prevent you from initialing all these statements, please explain: The NHS Faculty Council will review all of the documentation and make the membership approvals. I understand that the faculty/staff will have the opportunity to supply information about my character and leadership, which will only be viewed by the NHS Advisors, Faculty Council and Principal. Candidate Signature I have read and understand the process of National Honor Society selection. My son/daughter may be considered for induction into the Dublin Coffman High School National Honor Society. Parent(s) Signature Dublin Coffman High School National Honor Society has the right to dismiss a student accepted into NHS if any of the above issues should occur after induction. The student always has the right to appeal in writing to the advisors, faculty council, and/or principal.

5 LEADERSHIP VERIFICATION FORM School National Honor Society. This candidate requests that you complete the Leadership Verification Form, which will be submitted for consideration to his/her membership in the organization. The candidate will collect the form from you. _ Your Leadership Role/Position: Contact Info: Organization: Leadership Role affected: c High School Recommendation c Community Recommendation Describe duties or responsibilities you completed in this leadership role: To be completed by an adult sponsor (NO family members) Please be honest in your assessment of this student. _ Relationship to Candidate: Contact Info: Organization: Please rate the candidate s level of leadership for each description below using the scale: n/a not at all high cannot rate The student who exercises leadership: Is a dependable person Is a motivated, hard-working leader Is able to delegate responsibilities Inspires positive behavior and is a positive role model for others Is a timely, responsible, organized individual Please feel free to briefly state the capacity in which you have observed this candidate s leadership abilities. Add any comments that you feel the NHS Faculty Council should know that would help them to understand this student s leadership abilities to the fullest. Signature: Date:

6 LEADERSHIP VERIFICATION FORM School National Honor Society. This candidate requests that you complete the Leadership Verification Form, which will be submitted for consideration to his/her membership in the organization. The candidate will collect the form from you. _ Your Leadership Role/Position: Contact Info: Organization: Leadership Role affected: c High School Recommendation c Community Recommendation Describe duties or responsibilities you completed in this leadership role: To be completed by an adult sponsor (NO family members) Please be honest in your assessment of this student. _ Relationship to Candidate: Contact Info: Organization: Please rate the candidate s level of leadership for each description below using the scale: n/a not at all high cannot rate The student who exercises leadership: Is a dependable person Is a motivated, hard-working leader Is able to delegate responsibilities Inspires positive behavior and is a positive role model for others Is a timely, responsible, organized individual Please feel free to briefly state the capacity in which you have observed this candidate s leadership abilities. Add any comments that you feel the NHS Faculty Council should know that would help them to understand this student s leadership abilities to the fullest. Signature: Date:

7 LEADERSHIP VERIFICATION FORM School National Honor Society. This candidate requests that you complete the Leadership Verification Form, which will be submitted for consideration to his/her membership in the organization. The candidate will collect the form from you. _ Your Leadership Role/Position: Contact Info: Organization: Leadership Role affected: c High School Recommendation c Community Recommendation Describe duties or responsibilities you completed in this leadership role: To be completed by an adult sponsor (NO family members) Please be honest in your assessment of this student. _ Relationship to Candidate: Contact Info: Organization: Please rate the candidate s level of leadership for each description below using the scale: n/a not at all high cannot rate The student who exercises leadership: Is a dependable person Is a motivated, hard-working leader Is able to delegate responsibilities Inspires positive behavior and is a positive role model for others Is a timely, responsible, organized individual Please feel free to briefly state the capacity in which you have observed this candidate s leadership abilities. Add any comments that you feel the NHS Faculty Council should know that would help them to understand this student s leadership abilities to the fullest. Signature: Date:

8 CHARACTER VERIFICATION FORM School National Honor Society. This candidate requests that you complete the Character Verification Form, which will be submitted for consideration to his/her membership in the organization. The candidate will collect the form from you. Forms may be submitted to the candidate in a sealed envelope if you prefer. Contact Info: Character Role affected: c High School Recommendation c Community Recommendation To be completed by an adult sponsor (NO family members). Please be honest in your assessment of this student. Contact Info : Relationship to candidate: Please rate the candidate s level of character for each description below using the scale: n/a not at all high cannot rate The student who exercises character: Consistently exemplifies desirable behavior and self-discipline Complies with school/community regulations Demonstrates honesty & reliability Shows courtesy, concern, and respect for others Please feel free to briefly state the capacity in which you have observed this candidate s character abilities. Add any comments that you feel the NHS Faculty Council should know that would help them to understand this student s character abilities to the fullest. Signature: Date

9 CHARACTER VERIFICATION FORM School National Honor Society. This candidate requests that you complete the Character Verification Form, which will be submitted for consideration to his/her membership in the organization. The candidate will collect the form from you. Forms may be submitted to the candidate in a sealed envelope if you prefer. Contact Info: Character Role affected: c High School Recommendation c Community Recommendation To be completed by an adult sponsor (NO family members). Please be honest in your assessment of this student. Contact Info : Relationship to candidate: Please rate the candidate s level of character for each description below using the scale: n/a not at all high cannot rate The student who exercises character: Consistently exemplifies desirable behavior and self-discipline Complies with school/community regulations Demonstrates honesty & reliability Shows courtesy, concern, and respect for others Please feel free to briefly state the capacity in which you have observed this candidate s character abilities. Add any comments that you feel the NHS Faculty Council should know that would help them to understand this student s character abilities to the fullest. Signature: Date

10 CHARACTER VERIFICATION FORM School National Honor Society. This candidate requests that you complete the Character Verification Form, which will be submitted for consideration to his/her membership in the organization. The candidate will collect the form from you. Forms may be submitted to the candidate in a sealed envelope if you prefer. Contact Info: Character Role affected: c High School Recommendation c Community Recommendation To be completed by an adult sponsor (NO family members). Please be honest in your assessment of this student. Contact Info : Relationship to candidate: Please rate the candidate s level of character for each description below using the scale: n/a not at all high cannot rate The student who exercises character: Consistently exemplifies desirable behavior and self-discipline Complies with school/community regulations Demonstrates honesty & reliability Shows courtesy, concern, and respect for others Please feel free to briefly state the capacity in which you have observed this candidate s character abilities. Add any comments that you feel the NHS Faculty Council should know that would help them to understand this student s character abilities to the fullest. Signature: Date

11 SERVICE VERIFICATION FORM School National Honor Society. A verification form is required for each service activity or the hours will not be counted. The NHS Handbook s states that the service chosen should be done with a positive, courteous, and enthusiastic spirit... ; students are encouraged to use good judgment as they interpret the activity of service. Contact Info: Organization: Name of Service Activity: Date of Service Activity: Service benefited: c High School (only 5 hrs accepted) c Community Describe duties or responsibilities you completed as part of this service: I acknowledge this community service was completely voluntary to benefit the community and I did not receive any monetary or personal gain from this service. Candidate Signature Date: To be completed by an adult sponsor/advisor (NO family members or family friends): I agree to the above statements and acknowledge hours were accrued. This service was completely voluntary and did not result in any monetary and/or personal gain. Sponsor s Name: Sponsor s Signature: Phone: Please feel free to briefly add any comments that you feel the NHS Faculty Council should know that would help them to understand this student s service abilities to the fullest.

12 SERVICE VERIFICATION FORM School National Honor Society. A verification form is required for each service activity or the hours will not be counted. The NHS Handbook s states that the service chosen should be done with a positive, courteous, and enthusiastic spirit... ; students are encouraged to use good judgment as they interpret the activity of service. Contact Info: Organization: Name of Service Activity: Date of Service Activity: Service benefited: c High School (only 5 hrs accepted) c Community Describe duties or responsibilities you completed as part of this service: I acknowledge this community service was completely voluntary to benefit the community and I did not receive any monetary or personal gain from this service. Candidate Signature Date: To be completed by an adult sponsor/advisor (NO family members or family friends): I agree to the above statements and acknowledge hours were accrued. This service was completely voluntary and did not result in any monetary and/or personal gain. Sponsor s Name: Sponsor s Signature: Phone: Please feel free to briefly add any comments that you feel the NHS Faculty Council should know that would help them to understand this student s service abilities to the fullest.

13 ESSAY: Student Reflection of Leadership and Character The student who demonstrates leadership is resourceful, makes suggestions, demonstrates initiative, exercise positive influence on peers, contributes ideas, delegates responsibility, has a positive attitude, inspires positive behavior, demonstrates academic initiative, successfully holds positions of responsibility, is efficient, is reliable and dependable, upholds scholarship and maintains a loyal school attitude. Notice that leadership is not limited to elected positions. A person of character demonstrates respect, responsibility, trustworthiness, fairness, caring, and citizenship. A student of character takes criticism willingly and accepts recommendations graciously, consistently exemplifies desirable qualities of behavior including cheerfulness, friendliness, poise, and stability, upholds principles of morality and ethics, cooperates by complying with school regulations, demonstrates the highest standard of honesty and reliability, regularly shows courtesy, concern, and respect for others, observes rules and instructions, is punctual, has strong powers of concentration and selfdiscipline, demonstrates perseverance and application to studies, manifests truthfulness in acknowledging obedience to rules, avoids cheating in any form, shows unwillingness to profit from others mistakes, and actively helps rid the school of bad influences or environments. Please discuss your strength as a leader of good character in school and in the community. Take this opportunity to reflect upon how you exemplify the four pillars of National Honor Society (scholarship, leadership, service, character), focusing on leadership and character. This reflection must be typed (12 pt font or smaller) and demonstrate a level of thinking beyond merely listing activities. Minimum 1 full page.

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