Full Name ID Number Grade level

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1 Application for National Honor Society Mansfield Legacy High School 2016 Due Date: Tuesday, April 5, This is a firm deadline--even if you are absent. Directions: Complete ALL sections. Please type or print neatly. Completion of this form does NOT guarantee selection. Applications are due to Ms. Cavnar in S211. Please complete all sections of the information. Please print neatly and use dark ink. Do not be modest--all information will be considered by the Faculty Council in the selection process. Include information from 9 th grade on any junior high school activities will be considered last. Completing this form does not guarantee admission. This form requests verification signatures. Please try to get signatures (especially if that person is on our campus). Realizing that sometimes signatures may be difficult to obtain from past work experience or volunteer activities, you may have that person send an to Ms. Cavnar at kennacavnar@misdmail.org. Have them put NHS recommendation in the subject line. These must be received by the due date. If that is the case, please list their in the box instead of a signature. Please avoid using family members for verifications. PART 1 ADMINISTRATIVE INFORMATION Full Name ID Number Grade level Application Review Process April 5, 2016 by 3:15 p.m. Interim May 1 May 19 Applications due Faculty Committee Review Notifications Inductions I understand that completing this form does not guarantee selection into the National Honor Society and that the information presented here is accurate. I also understand that if selected for the National Honor Society I must attend meetings and functions as required. I recognize that I will be required to perform a minimum of 30 community service hours per year and maintain a GPA of 97 and may be removed from the society for failing to meet these requirements. Student Name Student signature Date Parent Name Parent signature Date

2 PART 2 SCHOLARSHIP 25% Your GPA on record must be at least a 97.0 to apply. There is no rounding up. Please attach a copy of your current schedule. PART 3 LEADERSHIP POSITIONS 25% List all elected or appointed leadership positions held in school, community or work activities. Include only those positions in which you were directly responsible for directing or motivating others. Activity Grades/Years participated Office Held Description/Accomplishments Contact person Signature Are there any other areas that you have shown leadership besides holding a direct office or title? Explain. If the above section is left blank, please explain why. PART 4 2

3 SERVICE/VOLUNTEER ACTIVITIES 25% List all the community service activities you have participated in that have benefited the school and/or the community. If you are a part of service class (Teen Leadership/Stuco/Ready-Set-Teach/Community Service), check the box if those activities were done as part of the class. Service Activity Grades/Years participated How Often class activity Description/Accomplishments Contact person Signature If the above section is left blank, please explain why. PART 5 3

4 EXTRA CURRICULAR ACTIVITIES List all extracurricular activities (school or otherwise) that you would like the committee to consider. Activity Grades/Years Description/Accomplishments Contact person Signature (or copy of award or work schedule) PART 6 P PART 5 4

5 ART WORK EXPERIENCE, RECOGNITION AND AWARDS List all (paid or volunteer) job experiences, honors and/or recognitions that you have received which support your bid to be selected for membership into the National Honor Society. Activity Grades/Years Description/Accomplishments Contact person Signature (or copy of award or work schedule) 5

6 PART 7 CHARACTER 25% In the past school year, Have you been sent to AC: For Dress Code? For ID? For Tardies? Other? Did you attend any Saturday Schools for attendance recovery? Have you been assigned Saturday detention for ID or Tardies? Have you ever received a 0 for cheating, copying or sharing answers? If you answered yes to any of the above questions, please explain. Please have your Assistant principal or their secretary sign off below that the information above concerning discipline is correct. Date *Additional assessment of character will come through teacher evaluations. PART 8 ESSAY Please type the following essay. It should be no more than a single page. Scholarship, Leadership, Character and Service are the four pillars of the National Honor Society. In what ways have you developed those qualities in your life and how do you think they will benefit you and your community in the future? 6