St. John’s Jesuit High School
Pedro Arrupe Chapter
of The
National Honor Society Application
Leadership~Service~Character~Scholarship
Instructions for application process:
Allow ample amount of time for all aspects of the application to be completed and submitted by March 6, 2017!
Applications are not considered complete until all components are submitted. Late applications will not be accepted. Application must be typed.
- Locate application on the St John’s website under academics and Honor Societies. Fill out application and print.
- Complete all aspects of the application.
- Request 2 teacher recommendation forms (attached to application form) be completed by teachers of your choosing.
- Submit AP form to AP’s office. (attached to application)
- Make sure to allow time for AP and teachers to complete your recommendation forms.
- Make sure application is paper clipped and placed in the box labeled NHS in the main office by 3:00pm on due date.
- Application checklist:
o Activities sheet
o Service sheet
o 2 teacher recommendations
§ Teacher 1______
§ Teacher 2______
o AP recommendation form
o Character Essay
§ Integrity
§ Men for Others
*****Turned in to main office by March 6, 2017*****
Please email or see Mrs. Jill Lipinski with any questions.
St. John’s Jesuit High School
National Honor Society Pedro Arrupe, S.J. Chapter
Web Application for Membership (must be typed)
Name: ______Date ______
Address:
City: State: Zip Code:
Phone:
Email:
Activities:
Please identify below the two activities that you consider to be major (there is a large time commitment involved).
First Major Activity:
Years Involved: 9 □ 10 □ 11 □ 12 □
Positions Held and/or Honors Received:
Briefly describe your involvement:
Moderator’s Signature: Date:
Moderator’s Comments:
Second Major Activity:
Years Involved: 9 □ 10 □ 11 □ 12 □
Positions Held and/or Honors Received:
Briefly describe your involvement:
Moderator’s Signature: Date:
Moderator’s Comments:
Other Activities
Activity / YearsInvolved / # Hours Per
Week / # Weeks Per
Year / Moderator
Signature
Service Activities:
SJJ Theology class: Describe any volunteer work you have done or are currently doing through
Theology class.
Location / #Hours/Week / #Weeks/Year / Nature of WorkFreshmen
Sophomore
Junior
SJJ Christian Service Work: Describe any volunteer work you have done or are currently doing through the St. John’s Volunteer Program that was NOT part of your theology requirement.
Location / #Hours/Week / Nature of WorkJunior:
Semester One
Junior: Semester Two
Christian Service Coordinator Signature:
Comments:
Outside Volunteer Activities (do not include hours from Theology class or Christian service here)
Organization / YearsInvolved / #Hours
Per
Week / # Weeks
Per Year / Nature of Work
You must attach a letter or email from your supervisors or leaders verifying above activities.
Character:
Have you ever received an integrity violation or a misconduct report, or have you ever been placed on disciplinary probation or suspended (either in-school or out of school) while at St. John’s Jesuit (if yes, please explain what occurred and what you learned from it):
______
______
Essay: In the space below, describe your most rewarding experience(s) as a St. John's Jesuit student and describe how it has helped to make you a "Man for Others."
______
______I hereby state that all information in this application is accurate and honestly presented. Applicant Signature:______Date:______
Submit to Main office by March 6, 2017
St John’s Jesuit High School pdf
National Honor Society Application
Teacher Recommendation Form
Applicant: Complete the top portion only.
Student Name: ______
Teacher Name: ______Date given to teacher: ______
This student is seeking to become a member of the National Honor Society. The Faculty Council would like your input to help make its decision.
What course did you teach this student and when? ______
Check the appropriate box that best describes the character of the student.
Attribute / Truly Outstanding (top 2-3%) / Excellent(Top 10%, but not top 2-3%) / Good / Average / Below Average / No Basis for Judgment
Responsibility
Maturity and self-discipline
Self-confidence
Sense of humor
Concern for others
Integrity
Reaction to setbacks
Compliance with school regulations
Cooperation with others
Recommendation: _____ recommend without reservation
_____ recommend with reservation (Please comment).
_____ do not recommend (Please comment).
Comments:______
Signature ______
Printed Name ______Date ______
Do Not Return form to the student!
Submit to Mrs Jill Lipinski’s mailbox by March 6, 2017
St John’s Jesuit High School pdf
National Honor Society Application
Teacher Recommendation Form
Applicant: Complete the top portion only.
Student Name: ______
Teacher Name: ______Date given to teacher:______
This student is seeking to become a member of the National Honor Society. The Faculty Council would like your input to help make its decision.
What course did you teach this student and when? ______
Check the appropriate box that best describes the character of the student.
Attribute / Truly Outstanding (top 2-3%) / Excellent(Top 10%, but not top 2-3%) / Good / Average / Below Average / No Basis for Judgment
Responsibility
Maturity and self-discipline
Self-confidence
Sense of humor
Concern for others
Integrity
Reaction to setbacks
Compliance with school regulations
Cooperation with others
Recommendation: _____ recommend without reservation
_____ recommend with reservation (Please comment).
_____ do not recommend (Please comment).
Comments:______
Signature ______
Printed Name ______Date ______
Do Not Return form to the student!
Submit to Mrs Jill Lipinski’s mailbox by March 6, 2017
St John’s Jesuit High School pdf National Honor Society Application AP Office Form
Applicant: Complete the top portion only and submit to Mr Root’s office
Student Name: ______Official Class: ______
To the Dean’s Office: This student is seeking to become a member of the National Honor Society. The Faculty Council would like your input to help make its decision.
Name of person completing form: ______
Please verify if the student has a Dean’s record:
______No, Student does not have a Dean’s office record.
______Yes, Student has a Dean’s office record. PLEASE COMPLETE SECTION BELOW.
_____ Number of DVC’s
_____ Number of Misconducts
_____ Student was suspended. Please list dates and infraction.
Incident 1: ______
Incident 2: ______
Recommendation: _____ recommend without reservation
_____ recommend with reservation (Please comment).
_____ do not recommend (Please comment).
Comments:______
Signature ______
Printed Name ______Date ______
Do Not Return form to the student!
Submit to Mrs Jill Lipinski’s mailbox by March 6, 2017