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National Honor Society Information Packet-- Do not write in pencil. Do not staple. Failure to follow these directions will result in an incomplete packet that will leave you out of the selection process. Your application is an important part of the selection process.

Somerset High School

Student Information Packet

For Applying to Somerset High School National Honor Society

Congratulations on your nomination for consideration to National Honor Society. You are to be commended on your hard work.

Note: Failure to follow these directions will result in an incomplete packet that will leave you out of the selection process. Your application is an important part of the selection process. Completion of this form does not ensure selection into NHS. Membership in NHS is not a right but a privilege.

·  This application must be typed

·  You may duplicate pages if needed to add in more activities, etc…

·  DO NOT STAPLE… paper-clip only

·  Signatures must be original and followed by printed name of signee

and two reliable phone numbers (SIGNATURES ARE VERIFIED)

·  You must turn COMPLETED application in by 3:00 pm est no later

than Friday, Sept. 6, 2013 to Mrs. Penley (DO NOT put on desk,

under door, etc… hand to her in person)

·  NOTE: It is to your advantage to turn this application in early as no

applications will be accepted after due date and time, even if you

have an excused absence. There are NO EXCEPTIONS

Full Name:

First Middle Last

( ) Phone # ( ) DOB / /

Preferred Name Area Code Cell Phone number Month Day Year

Home Address:

Street, Apt #, Rural Route, etc. City State Zip Code

Grade Social Security Number

Father’s Full Name :

Father’s Home Phone# ( ) Cell Phone ( ) Work Phone ( )

Father’s Home Address

Street, Apt #, Rural Route, etc. (Write SAME if same address as student City State ZiP Code

Mother’s Full Name:

First Middle Last

Mother’s Home Phone #( ) Cell Phone ( ) Work Phone ( )

Mother’s Home Address

Street, Apt #, Rural Route, etc. (Write SAME if same address as student City State ZiP Code

I understand if I am selected as a member of National Honor Society, I will abide by NHS rules, constitution, and by-laws (available upon request). I realize that I risk dismissal upon any violation of these rules, which includes falling below the required GPA of 3.60, a violation in character or leadership, and not participating in the required number of service hours. I also understand the service requirement of 20 hours prior to my senior year, and an additional 20 hours of service during my senior year. All service hours must be pre-approved before submission. 10 hours must be completed & submitted between May 1, 2013 & December 31, 2013. 10 hours must be completed & submitted between January 1, 2014 & April 29, 2014. ALL I have reviewed this application and understand that completing this form does not guarantee selection to NHS, and that the information presented here is accurate. For additional information, please contact the NHS adviser, Mrs. Lynette Penley at

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Student Signature Date

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Parent/Guardian Signature Date


Student Questionnaire

Name of Candidate: ______

Directions: Please type or print in black ink clearly. Do not write in pencil. Do not staple. Your application is an important part of the selection process.

The object of the National Honor Society is to create an enthusiasm for scholarship, to stimulate a desire for service, to promote worthy leadership, and to encourage the development of character in all students of Somerset High School.

In no less than 100 words, explain what contributions you have made to the school, classmates and the community. (Include any fundraising activities in school or community, volunteer work, assisting teachers and administration, and extra-curricular activities as related to school or community.) Please write in paragraph form.

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In no less than 100 words, explain through what leadership you have promoted school spirit at Somerset High School. Attendance, and active participation in, activities that reflect a positive spirit on Somerset High School are some examples of leadership. This does not mean simply list clubs, but to explain how you have promoted your school by involvement. This is not a list but should be done in paragraph form.

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In no less than 100 words, explain what or how you think you will contribute to National Honor Society if selected. Please write in paragraph form.

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Student Profile

I. Service/Community Activities—List service activities in which you have participated and note any major accomplishment in each. 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. Include clubs, teams, musical groups, etc., and major accomplishments in each. For example: church groups, clubs sponsored inside or outside the school, Boy or Girl Scouts, or community art endeavors. Please list the name of an adult supervisor who can verify your participation in each activity.

Service Activity Completed / 9th / 10th / 11th / 12th / Approximate
Total hours / Major
Accomplishments / Signature of
Adult Sponsor* / Typed Name of Sponsor & two phone numbers of Sponsor
Example: Nursing Home visitation / X / X / 5 / Visited Nursing Home 5 times / Lynette Penley / Lynette Penley
222-333-4444 or 222-333-5555
Student Profile

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 selection.

II. Leadership Activities 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 editor; work area manager; or community leader.
Activity/Club / 9th / 10th / 11th / 12th / Accomplishments / Signature of
Adult Sponsor* / Typed Name of Sponsor & two phone numbers of Sponsor
Example: BETA / X / Secretary / Heather Massey / 111-222-333 or 222-333-444

III. Work Experience, Recognition, and Awards- List below any job experiences, honors, or recognition

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 / 9th / 10th / 11th / 12th / Number of Hours Spent on Job or Volunteer Activity / Signature of
Adult Sponsor* / Typed Name of Sponsor & two phone numbers of Sponsor
Example: Rocky Hollow time keeper / X / 120 / John Doe / John Doe 222-333-4444 or 123-456-7890
Example: Spanish Award / X / 2012-2013 school year / Jane Doe / Jane Doe 222-333-4444 or 123-456-7890

IV. Other Considerations: If you feel there are any other circumstances or considerations that need to be taken into account by the faculty council that will aid them in making the decision whether or not you are accepted into NHS, please use this space to list these:

V. FYI

·  Your adviser is only the facilitator and has no say in whether or not you are accepted into NHS. This will be left up to the 5 member faculty council. These members will remain anonymous to NHS applicants.

·  To be accepted, you must receive a minimum of three “yes” votes from three of the five faculty council members.

·  Faculty council members will perform “blind” scoring (i.e. they will not see other scores from the other four members). The only exception to this is if an applicant receives two “no” votes, two “yes” votes, and one “maybe” vote OR two “no” votes, one “yes” vote, and two “maybe” votes OR two “no” votes and three “maybe” votes. In any of these cases, the faculty council will meet and discuss the applicant and come to a majority consensus.

·  In order to be accepted into NHS, you MUST show evidence of all four areas: Scholarship (3.60 GPA or above), Leadership, Service, & Character.

·  Scholarship is determined by your cumulative GPA

·  Leadership & Service are largely determined by this application

·  Character is determined by this application and a discipline and attendance report from your freshman year to current year.

·  Lastly, a part of the faculty council evaluation consists of SHS teacher surveys. These surveys ask all SHS teachers to rank each student applicant in Leadership, Service, and Character. Should a teacher be unaware of one or more of these categories, they will choose “N/A” as an option.