Aprende Jaguar Chapter of the NATIONAL JUNIOR HONOR SOCIETY Student Activity Information Form (NOT AN APPLICATION FORM) RETURN TO MRS. FURMAN IN ROOM 203 BY April 10, 2015 Directions: Please complete all sections. Do not be modest. Every bit of information can be used by the Faculty Council to assist with the selection process. Completion of this form does not guarantee membership. Please print with blue or black ink ONLY. I. Administrative Information: Name: Street Address: City:, AZ Zip Code: Phone Number: Student ID#: 6 th Period Teacher: Academic Lab Teacher: II. Co-curricular Activities: List all activities in which you have participated during middle school. Include clubs, teams, musical groups, etc., and major accomplishments in each. Activity Accomplishments 1
III. Leadership Positions: List all elected or appointed leadership positions held in school or community activities in middle school. Only those positions in which you were directly responsible for directing or motivating others should be included. For example: elected student body, class, or club officer; committee chairperson; team captain; newspaper editor; peer mentor; or community leader. Elementary leadership experience does not qualify for the purpose of this organization. Leadership Position Activity or Organization IV. Community Activities: List community activities in which you have participated and note any major accomplishment in each. These should be any activities outside of school in which you participated for the betterment of your community. For example: church groups, clubs sponsored outside the school, Boy or Girl scouts, volunteer groups, or community art endeavors. Please have the appropriate sponsor/adult leader sign to verify your participation in these activities. The signature should not be a parent signature. Community Activity No. of Hours/Wk Major Accomplishment Signature of Adult Sponsor 2
V. Work Experience, Recognitions, and Awards: List below any job experiences, honors, or recognitions that you have received which support your bid to be selected for membership in the National Junior Honor Society. Work experience may be paid or volunteer. Elementary honors and awards do not qualify for the purpose of this organization. Job, Recognition, Or Award Group or Activity/ Number of hours Spent on Job or Volunteer Activity VI. Signatures: I understand that completing and submitting this form does not guarantee selection to the Aprende Jaguar Chapter of National Junior Honor Society. I attest that the information presented here is complete and accurate. If selected, I agree to abide by the standards and guidelines of the chapter and to fulfill all of my membership obligations to the best of my ability. Student 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. Parent Signature Date Please submit completed packet to Mrs. Furman in room 203 by April 10, 2015. 3
IV. Letter of Intent: Please address a formal letter to the members of the Faculty Council who are selecting you for membership. Your letter should address the following key ideas concerning why NJHS will benefit from having you as a member: How much time are you willing to commit to your membership with NJHS? Will you be comfortable making service and leadership a priority among your other middle school obligations? How will you balance your time and energy? What one pillar of character do you exemplify the most? How does that pillar of character make you best qualified to be in NJHS? What do you hope to gain by being a member in NJHS? How will membership help you grow (personally and/or academically) in middle school? Finally, why did you choose to complete the process of becoming a member of NJHS? Letters must be submitted as a student-written, hand-written copy on this Student Activity Informational Form only. Letters may not be longer than the provided form. 4
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