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Nation Honor Society Application

Salome High School Excelsior Chapter

of the National Honor Society

 

Directions: Please complete all sections.  (Please type of print)  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 selection.

 

I. Administrative Information

 

Name: __________________________________________________________________

 

 

II. Co-curricular Activities – List all activities in which you have participated during high school.  Include clubs, teams, musical groups, etc., and any major accomplishment in each.

 

 

Activity

Year

Accomplishments

 

9

10

11

12

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

III. Leadership Positions – 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 or motivating others should be included.  For example, elected student body, class, or club officer; committee chairperson; team captain; newspaper/yearbook editor; work area manager; or community leader.

 

 

Activity

Year

Accomplishments

 

9

10

11

12

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


IV. Service Activities – List all 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 projects performing service.  Generally speaking, service activities are those which are done for or on behalf of others (not including immediate family members) for which no compensation (monetary or other) has been given.  Examples would include 4-H, Girl/Boy Scouts, church, or other group service projects.  Please list the name of an adult supervisor who can verify your participation in each activity.

 

 

Activity

Year

Adult Sponsor

 

9

10

11

12

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

V. Other Community Activities – List other community activities in which you have participated and note and major accomplishment 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 sponsored outside the school, Girl/Boy Scouts, or community art endeavors.  Do not repeat participation already listed above.

 

 

 

Community

Year

Hours/Week

Major

Signature of

Activity

9

10

11

12

 

Accomplishments

Adult Sponsor

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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.

 

Job, Recognition, or Award

Year

Group or Activity/Number of

 

9

10

11

12

Hour Spent on Job or Volunteer Activity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I understand that completing this form does not guarantee selection to NHS, and that the information presented here is complete and accurate.

 

 

­­­­­­­­­­­­­­­­­Student Signature                                                                             Date

 

 

 

 

 

I have read the information provided by my student on this form and can verify that it is true, accurate, and complete in its presentation.

 

 

Parent Signature                                                                               Date

 

 

 

 

**In addition, please submit a typed letter explaining why you should be accepted into the Salome High School Excelsior Chapter of National Honor Society.  Please focus on the four characteristics: Scholarship, Leadership, Service, and Character.**