National Honor Society

Student Activity Information Form

Please complete all sections of the following form. Do NOT be modest. Every bit of information can be used to assist in the selection process. Completion of this form does not guarantee selection. This form should be word processed.

I.  Administrative Information

Name______

II.  Cocurricular Activities

List all activities in which you have participated during high school. Include clubs, teams, musical groups, etc., and major accomplishments 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. Examples include elected student body, class or club officer; committee chairperson; team captain; newspaper editor; manager; or community leader.

Leadership Position

/

Year

/

Activity or Organization

9 / 10 / 11 / 12

IV.  Community Activities

List community activities in which you have participated and note any major accomplishments in each. These should be any activities in which you participated for the betterment of your community.

Activity

/

Year

/

Hours

/

Adult sponsor signature or name and phone number

9 / 10 / 11 / 12

V.  Scholarship

List below any classes that you have taken that are classified as DC, AP, CAPP, or Honors.

Class

/

Year

9 / 10 / 11 / 12

VI.  Personal Statement

Please include a personal statement that describes your attributes, your accomplishments, your services to school and community, and explain why you would be a good National Honor Society member.