National Honor Society Nonnewaug High School Chapter Student Activity Form This form, completed in its entirety, must be returned to Mrs. Yard in room 132 no later than November 26th, 2014. Partially completed activity forms will not be considered for selection. Directions: Please complete all sections. (Please type or print) Do not be modest. Every bit of information you provide can be used by the Faculty Council to assist with the selection process. Please be aware that completion of this form does not guarantee selection. I. Administrative Information Name Grade Advisory Teacher and Room Number II. Cocurricular Activities Please list below all activities in which you have participated through the school, during high school. Include clubs, teams, musical groups, etc. Be sure to list any major accomplishments in each activity. Activity Year Accomplishments 9 10 11 12 Choose any two of the above activities and explain your role within the activity (Only use the space provided):
III. Leadership Positions The requirement for leadership is that each candidate must have occupied one or more continuous and recognized leadership within the school or community during high school. Candidates who do not meet this requirement must demonstrate a unique and exceptional ability for leadership in the school or classroom environment, as determined by the faculty council. List all elected or appointed leadership positions held in school, community, or work activities. Only those positions in which you were directly responsible for directing and/or motivating others should be included, for example, elected student body, class, or club office, committee chairperson, team captain, newspaper editor; work area manager, or community leader. Activity Year Accomplishments 9 10 11 12 If you did not hold any leadership positions, please provide a description of how you have exercised positive influence on your peers through directing and motivating (Only use the space provided):
IV. Service Activities The requirement for service is that each candidate will submit his/her community, school, religious or other service projects for review by the faculty council. Community service is defined as assisting others through the contribution of time and services without tangible compensation. Each candidate must demonstrate two or more cases of recognized participation in community service projects within the school or local community, and one or more cases of recognized participation that is an ongoing community service project in which the candidate contributed over time. Combined, these projects should total at least 60 hours of service throughout high school. (Please note that only those SAE hours that surpass the required 200 hours will be considered in meeting the service requirement.) List service activities in which you have participated. These can be service projects done with a group either in or out of school, or done as individual service projects. Generally speaking, service projects are those done for or on behalf of others (not including immediate family members) for which no compensation (monetary or other) has been given. Please list the name and contact information (either e-mail address or phone number) of an adult supervisor who can verify your participation in each activity. Activity Year and Hours (please denote Adult Sponsor weekly, monthly, or annually) 9 10 11 12 Contact information
V. Other Community Activities List other community activities in which you have participated and note any major accomplishments in each. These should be any activities outside of school in which you participated for the betterment of your community. For example: religious groups, clubs or sports sponsored outside the school, Boy or Girl Scouts, or community art endeavors. Do not repeat participation already listed previously. Community Activity Year Hours per week Major Adult Sponsor 9 10 11 12 Accomplishments Contact Info VI. Work Experience, Recognition, and Awards List below any job experiences, honors, or recognition that you have received that support your bid to be selected for membership in the National Honor Society. Work experience may be paid or volunteer. Do not repeat participation already listed previously. Job, Recognition or Award Year Group or Activity 9 10 11 12 # of hours Spent on Job or Volunteer Activity
VII. Character The requirement for character is the continuous demonstration of respect, honesty, fairness, compassion, ethics, and citizenship: a candidate of good character is a role model within the school. Please provide the names of two faculty members that would attest to your character. Please have them sign this form below: 1. Name: Signature: 2. Name: Signature: Please answer the following question using only the space provided. What does character mean to you?
VIII. Membership Please answer the question using only the space provided. Why do you want to be selected as a member of the National Honor Society? What do you feel your roles and responsibilities will be upon selection? I understand that completing this form does not guarantee selection to National Honor Society. I affirm that the information presented here is complete and accurate. Applicant s Signature Date I have read the information provided by my son/daughter on this form and can verify that it is true, accurate and complete in its presentation. Parent or Guardian of Applicant s Signature Date