2011 Bethel Park National Honor Society

The purpose of the National Honor Society is to “create enthusiasm for scholarship, to stimulate a desire to render service, to promote leadership, and to develop character in the students of secondary schools.” The Bethel Park chapter of the National Honor Society will uphold the four NHS pillars of Character, Scholarship, Leadership, and Service.

2011 Bethel Park National Honor Society

Scholars Program

I. Personal Information:

Student ID Number ______Male _____Female _____

Date of Birth _____ /______/______

Address ______

______

Telephone (______) ______- ______

II. Academic Information

(A copy of your transcript should be attached. Your name should be cut off, but your student ID MUST be on it)

SAT Critical Reading Score ______SAT Math Score ______SAT Writing Score ______

ACT Composite ______

SAT II Subject TestSubject ______Score ______

AP ExamSubject ______Score ______

Cumulative QPA ______

Total Number of: AP classes in high school (including this year) ______Honors ______

Name of post-secondary school you plan to attend

______□I have been accepted

○ 4-year College or University○ Vocational-TechnicalSchool

○ 2-year Community/Junior College○ Other, please explain ______

Intended major or course of study

______

Degree sought

○ Bachelor○ Associate○ Certificate○ Other, please explain ______

Senior Year Courses

Course Name / Half/Full Year / Course Name / Half/Full Year

III. Activities

A resume does not replace any part of this application. If the space provided is inadequate, an additional sheet may be attached. All attachments must follow the same format as the application. Please do not repeat any information already reported on this form. Include your student ID number on any attached sheets.

Please list any academic activities in which you have participated:

Activity / Leadership Positions / Special Awards/Honors / Years of Participation
9 / 10 / 11 / 12

Please list any non-academic (clubs, sports, community, etc.) activities in which you have participated:

Activity / Leadership Positions / Special Awards/Honors / Years of Participation
9 / 10 / 11 / 12
Activity / Leadership Positions / Special Awards/Honors / Years of Participation
9 / 10 / 11 / 12

Please list any additional awards or honors you have received:

______

IV. Community Service

Please list any volunteer activities in which you have participated:

Activity / Leadership Positions/Awards or Honors / Number of Hours / Years of Participation
9 / 10 / 11 / 12

V. Character

Have you received any official disciplinary action throughout high school? If so, please explain

□ No

□ Yes ______

Have you ever been convicted of a misdemeanor, felony, or other crime? If so, please explain

□ No

□ Yes ______

PLEASE INCLUDE ONE (1) TEACHER RECOMMENDATION. YOUR NAME SHOULD NOT APPEAR ON THIS RECOMMENDATION. INSTEAD, THE TEACHER SHOULD USE YOUR STUDENT ID.

VI. Financial Information

Work Experience

Please list any employment you have had in the past four years:

Employer/Position / From (Month/Year) / To (Month/Year) / Hours/Week / Amount Earned

Father or Guardian’s Occupation ______

Mother or Guardian’s Occupation ______

Siblingsage ______

Is he/she attending a college/university□ Yes______□ No

SCHOOL NAME

age ______

Is he/she attending a college/university□ Yes______□ No

SCHOOL NAME

age ______

Is she/he attending a college/university□ Yes______□ No

SCHOOL NAME

age ______

Is she/he attending a college/university□ Yes______□ No

SCHOOL NAME

Other Dependents ______

______

Approximate Annual Family Income$ ______

Estimated Cost of Annual Tuition$______

If you have been offered any scholarships, please list them below with the dollar amount of award.

______$______

How do you plan to finance your education?

______

VII. Essay

On a separate sheet, describe an extracurricular activity in which you were a leader. Discuss the impact this experience had on you. This experience does not need to be NHS related.

Please type your double-spaced essay and limit it to 500 words. Remember: Your name cannot appear in the essay. PUT YOUR STUDENT ID AT THE TOP OF THE PAGE.

Please include any additional information you feel the committee should consider when evaluating your application:

______

------Detach here and turn in bottom portion separately------

STUDENT ID NUMBER: ______

I acknowledge that the decisions of the NHS Scholars Program committee are final. I certify that all information in my application is my own work, factually true, and honestly presented. If necessary, I authorize the release of my high school transcripts. I am aware that any falsification of information will result in the rejection of my application.

______

SignatureDate

2011 Bethel Park National Honor Society

Scholars Program

The Bethel Park National Honor Society awards two $1,000 scholarships to one male and one female senior NHS member. The $1,000 nonrenewable scholarship is payable towards the student’s first undergraduate year at an accredited college. To qualify for this scholarship, the student must be a senior NHS member in good standing, as of the deadline, and must graduate in 2011.

The selection of criteria is based on a combination of financial need, academic merit, leadership ability, character, work experience, and community service. Faculty members of the NHS Scholars Program committee will review the anonymous applications. Scholarship winners will be notified in May.

The completed application should be returned to the Mr. Lorenzi no later than Wednesday, May 18th. No student may see the application after it is evaluated by the committee.

Any questions should be directed to Mr. Lorenzi().

NHS reserves the right to revise any conditions of the NHS Scholars Program.