Central Bucks High School South National Honor Society
Important Information for NHS Candidates:
*A Faculty Selection Committee determines membership based on established criteria:
- academic achievement
- service to school (as an ongoing commitment)
- service to community
- demonstration of leadership
- character (no record of cheating, intentional dishonesty, violating school rules or
civil offenses in the community)
Direction Guidelines:
* Carefully read the directions above each section of the information packet.
* Documentation is required for each section. Give yourself ample time to procure it.
* Only list activities and awards that were completed after ninth grade.
* Do not list the same activity in more than one category.
* Do not list activities in one section that are affiliated with clubs in another section.
* Do not attach anything you would like returned to you. Attach copies instead.
* All information should be typed on the forms provided.
* The student desiring membership must complete this form.
* Forms and documentation must be submitted in a 9 x 12" envelope by 3:30 pm
on September 11, 2009 (Friday) (no exceptions)to Mrs. Hoesly, secretary to Mr.
Stone.
I certify that I completed the attached Activity Information Sheet, and the information I provided in the attached form is accurate and complete:
Name ______(please print)
Present Grade Level ______
Signature of Student ______Date ______
Signature of Parent/Guardian ______Date ______
Address ______
Information Sheet: #______(To be entered by Mrs. Hoesly)
Student will receive written verification noting the time and date of application submission.
Information Sheet #______(To be filled in by Mrs. Hoesly)
Present Grade Level ______
Section I: School Activities (Service, Clubs, and Sports)
List all school activities and circle the year or years in which you participated in them; clubs, teams, and certain musical groups are examples of school activities. Estimate the time you spend on each activity. Do not include activities you intend to participate in for the 2009-2010 school year.
***FOR EACH SCHOOL ACTIVITY, YOU MUST RETURN A SIGNED & SEALED "IN SCHOOL" EVALUATION FROM YOUR ADVISOR. (The "In-School Evaluation Form" is attached at the end of this packet. Make as many copies as needed for each activity.)
______10 11 12 Hours/week ____ Weeks/year ____
______10 11 12 Hours/week ____ Weeks/year ____
______10 11 12 Hours/week ____ Weeks/year ____
______10 11 12 Hours/week ____ Weeks/year ____
______10 11 12 Hours/week ____ Weeks/year ____
______10 11 12 Hours/week ____ Weeks/year ____
______10 11 12 Hours/week ____ Weeks/year ____
______10 11 12 Hours/week ____ Weeks/year ____
Section II: Leadership Positions
List all elected or appointed leadership positions that you have held in school, the community, or at work. Only positions in which you were directly responsible for leading or motivating others are applicable, such as class/club officer, team captain, work manager, or newspaper editor.
*** FOR THIS SECTION, MAKE SURE YOU ASK THE ADULT SUPERVISOR TO INDICATE YOUR LEADERSHIP ROLE ON AN "IN-SCHOOL" OR "OUT-OF-SCHOOL" ACTIVITY FORM.
Leadership Position Grade(s) Activity or organization Adult name/phone #
______
Section III: Service to Community (use back of sheet if necessary)
DEFINITION: Community service activities are those that are done for or on the behalf of others (outside of family & school) for which no compensation has been given. Juniors are expected to have performed at least 10 hours of community service since the end of 9th grade. Seniors are expected to have performed at least 15 hours.
*** FOR THIS SECTION, YOU MUST GIVE AN "OUT-OF-SCHOOL" EVALUATION FORM TO A SUPERVISING ADULT FOR EACH COMMUNITY SERVICE ACTIVITY IN WHICH YOU PARTICIPATED. (The "Out-of-School evaluation Form" is attached at the end of this packet. Make as many copies as needed for each activity.)
Community Activity: ______Grade 10 11 12
Number of hours per week: ______Number of weeks per year: ______
Adult Sponsor's Name: ______Sponsor's Phone #: ______
Sponsor's Address: ______
Community Activity: ______Grade 10 11 12
Number of hours per week: ______Number of weeks per year: ______
Adult Sponsor's Name: ______Sponsor's Phone #: ______
Sponsor's Address: ______
Community Activity: ______Grade 10 11 12
Number of hours per week: ______Number of weeks per year: ______
Adult Sponsor's Name: ______Sponsor's Phone #: ______
Sponsor's Address: ______
Community Activity: ______Grade 10 11 12
Number of hours per week: ______Number of weeks per year: ______
Adult Sponsor's Name: ______Sponsor's Phone #: ______
Sponsor's Address: ______
Community Activity: ______Grade 10 11 12
Number of hours per week: ______Number of weeks per year: ______
Adult Sponsor's Name: ______Sponsor's Phone #: ______
Sponsor's Address: ______
Section IV: Other Activities (non-service related), Awards, and/or Information
(Optional section. No evaluation forms or letters required for this section.)
While this section is not a requirement for membership, you may use this space to list any other community activities in which you participate (work, musical lessons, sports teams), awards you have received, and/or any information which you believe is pertinent to your nomination for selection.
______
CENTRAL BUCKS SOUTH NATIONAL HONOR SOCIETY
IN-SCHOOL ACTIVITY EVALUATION FORM
(make copies as needed for section I)
TO BE COMPLETED BY APPLICANT
Name of Member: ______
Activity: ______
Number of years of participation: ______
TO BE COMPLETED BY ADVISOR/COACH/COORDINATOR OF ACTIVITY
We are considering a member of your activity for induction into the National Honor Society. We would like you to evaluate the member based on a 1 to 2 point system for each year of service. If the student is in eleventh grade, we will consider participation from grade 10 for a maximum of 1 year of service. If the student is in twelfth grade, we will consider participation from grades 10 & 11 for a maximum of 2 years of service.
You may give the student a different number of points for each year based on his/her level of participation. If you have any additional comments concerning the student's level of participation in the activity, please add them on the back of this sheet. Please evaluate the student based on the following scale:
2 - Student met the requirements of participation in this activity.
1 - Student participation in this activity was minimal.
*Is this student an elected or appointed leader in your activity? ______If yes, please describe the nature of leadership responsibility on the back of this sheet.
Advisor/Coordinator of Activity: ______
Advisor's Phone Number: ______
Number of points for 1st year of participation: _____
Number of points for 2nd year of participation: _____
Total number of points: _____
After completion, this form should be placed in a sealed envelope (provided by student), signed over the seal, and returned to the student. Thank you for your time.
CENTRAL BUCKS SOUTH NATIONAL HONOR SOCIETY
OUT-OF-SCHOOL ACTIVITY FORM
TO BE COMPLETED BY APPLICANT:
Name of Member: ______
Activity: ______
Length of Time in Activity: ______
FOR THE ADVISOR/COACH/EMPLOYER/COORDINATOR
We are considering a member of your activity for induction into the National Honor Society. For the purpose of examining their level of service, commitment, and leadership, the student should have requested from you a letter confirming their involvement. Ideally, this letter should be on company letterhead, and include the nature of service, date(s) the service was performed, number of hours of service, and any leadership positions held by the student.
Please attach the letter to this form and place in a sealed envelope (provided to you by the student), sign over the seal, and return to the student. Thank you for your time.