Name (print)______

National Honor Society

Application for Membership

MethactonHigh School

2015 - 2016

CHARACTER

SCHOLARSHIP

LEADERSHIP

SERVICE

Congratulations, you have been nominated to apply for Methacton High School’s chapter of the National Honor Society. Only juniors and seniors with a cumulative unweighted grade point average of 90% or above may apply. If you are interested in becoming a member, please fill out the attached application. The following checklist may be of assistance to you to ensure a complete application.

______1.) Student Information

______2.) Student and Guardian Signatures

______3.) Leadership Sponsor Rating Chart with Signatures

______4.) Leadership Short Answer

______5.) Listing of Service Activities with Advisor Validation

______6.) Five Completed Character Evaluations with Advisor Validation

______7.) Two Completed Essays

Selection Process:

Selection to NHS is a privilege, not a right. Students do not apply for membership in the National Honor society; instead, they provide information to be used by the local selection committee to support their candidacy for membership. Membership is granted only to those students selected by the Faculty Council in each school. This is not an election, nor is membership automatically conveyed simply because a student has achieved a specified level of academic performance. NHS is more than just honor roll. Methacton’s local chapter of the NHS emphasizes the components of leadership, service, and character in the selection process.

By completing this application, you have acknowledged that you accept the process of selection by the faculty council and understand that selection is final. The detailed, step-by-step process can be found on Methacton High School’s website under Activities>NHS.

Deadline: This application must be completed and returned to Mr. Adoff (C251) or Mr. Chapin (C218)by Friday,October 2, 2015 by 2:30 p.m. Applications not received or fully completed by this date will not be considered. If you have any questions, there will be an informational question and answer meeting on Thursday,September 10, 2015, in the LGI at 2:30 p.m. If you cannot make this meeting, feel free to contact Mr. Adoff or Mr. Chapin by e-mail at either or .

As a member of National Honor Society, you must physically be involved in at least 75% of the activities sponsored by the National Honor Society.

Signature:Upon completion, please finalize this application by signing below.

Applicant:______date______

Parent/Guardian:______date______

STUDENT INFORMATION

Name______

LastFirstMiddle

Grade(2015 - 2016)______Homeroom______Student ID Number______

Address______

StreetCityStateZip code

Phone Number______

E-Mail Address (Please Write Very Clearly)______

To be completed by your guidance counselor

Unweighted Cumulative GPA______Class Rank______

List any discipline referrals this student has received since freshman year. Please be sure to include the date of the referral as well as a brief description of the issue(s).

Guidance Counselor Signature______Date______

Leadership:

The leadership criterion is considered highly important for membership selection. Some Faculty Councils may wish to interpret leadership in terms of the number of offices held in school or community organizations. It is important to recognize that leadership also exists outside elected positions including effective participation in other co curricular activities offered on campus. Other Faculty Councils may define leadership in less objective terms. Leadership roles in both the school and community may be considered, provided they can be verified.

The student who exercises leadership:

  • Is resourceful in proposing new problems, applying principles, and making suggestions
  • Demonstrates initiative in promoting school activities
  • Exercises positive influence on peers in upholding school ideals
  • Contributes ideas that improve the civic life of the school
  • Is able to delegate responsibilities
  • Exemplifies positive attitudes
  • Inspires positive behavior in others
  • Demonstrates academic initiative
  • Successfully holds school offices or positions of responsibility; conducts business effectively and efficiently; demonstrates reliability and dependability
  • Is a leader is the classroom, at work, and in other school or community activities
  • Is thoroughly dependable in any responsibility accepted
  • Is willing to uphold scholarship and maintain a loyal school attitude.

Name (print)______

Leadership Positions: List all titled, elected or teacher/supervisor appointed leadership positions held in school, community, or work activities. For example, elected student body, class, or club officer; committee chairperson; team captain; newspaper editor; work area manager; or community leader are all positions that satisfy this criteria. Please feel free to include a letter of recommendation from someone outside the school who may be familiar with your leadership positions.

Advisor Rating:Please rate the candidate on his/her leadership abilities. Use the following rating scale:

1Superior: The student is a superior leader who inspires others to get involved. His/her actions exemplify that of a true leader and he/she is truly respected by peers. As a dedicated leader, he/she looks for new ideas and goes above and beyond to succeed.

2Average: The student is an average leader, usually able to motivate others to participate and get involved. No complaints surface regarding leadership abilities.

3Poor: The student does not always do his/her job and does not serve as an appropriate role model for a leader.

Activity / Leadership
Position / 9 / 10 / 11 / 12 / Rating / Advisor Signature / Advisor Name (printed)
Contact Phone Number

EXPAND: Feel free to expand on any or all of the leadership positions listed above.

Name (print)______

SHORT ANSWER:Please list other areas where you exhibit leadership qualities without holding a leadership title. Be specific and include examples of the leadership qualities you feel these positions exhibit.

Service:

Service is generally considered to be those actions taken by the student which are done with or on behalf of others without any direct financial or material compensation to the individual performing the service. In considering service, the contributions this candidate has made to school, classmates, and community, as well as the student’s attitude toward service can be reviewed.

The student who serves:

  • Volunteers and provides dependable and well organized assistance, is gladly available, and is willing to sacrifice to offer assistance
  • Works well with others and is willing to take on difficult or inconspicuous responsibilities
  • Cheerfully and enthusiastically renders any requested service to the school
  • Is willing to represent the class or school in inter-class and inter-scholastic competition
  • Does committee and staff work without complaint
  • Participates in some activity outside of school- for example: Girl Scouts, Boy Scouts, church groups, volunteer services for the elderly, poor, or disadvantaged
  • Mentors persons in the community or students at other schools
  • Shows courtesy by assisting visitors, teachers, and students.

Name (print)______

SERVICE ACTIVITIES

Please list all the service activities in which you have participated through the course of the school year. A minimum of two of the following three types of service are recommended.

1.)In School or School Related

Athletic Teams and Clubs/Organizations in school that involve service

2.) Out of School

Clubs/Organizations such as Boy/Girl Scouts, Church Groups, Serving the Elderly, Children or the Disabled, etc.

______

Advisors, please rate the level of involvement for service activities by checking choices

1- Very Involved (+75%)

2- Involved (50%)

3- Somewhat Involved (25%)

4- Rarely or Not Involved

Service Activity / 1 / 2 / 3 / 4 / Advisor Signature / Advisor Name (printed)
Contact Phone Number

***PLEASE NOTE: This form will be accepted only with advisor validation***

Character:

National Honor Society is a member of the Character Counts! Coalition. Through this activity, the society supports and recommends the use of a multi-faceted definition of character known as the “Six Pillars of Character.” A person of character demonstrates the following six qualities: respect, responsibility, trustworthiness, fairness, caring, and citizenship. Schools are encouraged to take this model, modify it to meet their local needs, and utilize it frequently in the work of their chapter.

In addition, it can also be said that the student of character:

  • Takes criticism willingly and accepts recommendations graciously
  • Consistently exemplifies desirable qualities of behavior (cheerfulness, friendliness, poise, stability)
  • Upholds principles of morality and ethics
  • Cooperates by complying with school regulations concerning property, programs, office, halls, etc.
  • Demonstrates the highest standards of honesty and reliability
  • Regularly shows courtesy, concern, and respect for others
  • Observes instructions and rules, is punctual, and faithful both inside and outside the classroom
  • Has powers of concentration, self-discipline, and sustained attention as shown by perseverance and application to studies
  • Manifests truthfulness in acknowledging obedience to rules, avoiding cheating in written work, and showing unwillingness to profit by the mistakes of others
  • Actively helps rid the school of bad influences or environment.

WRITTEN RESPONSE

Discuss two of the following essay topics. One of the two essay topics chosen must be from the Character category. Each essay should be two hundred words or less and must be typed. Please be attentive to content, style and conventions.

Character:

1.)Describe a real situation that presented a challenge for you that tested your character.

2.)Write a chapter of your own biography that demonstrates your character.

Leadership:

1.)How would you improve the civic life at Methacton High School?

Service:

1.)Pick a specific service experience you have had. Explain why you choose to serve this activity and how did this benefit those you served?

National Honor Society – Evaluation of Character

______(name) is in the process of applying for induction to the National Honor Society. Please complete this survey to give NHS a reflection of CHARACTER for the applicant. Thank you for your cooperation.

Would you describe this person as:

Very Strong Strong Average Below Average Minimal

Dependable54 3 2 1

Even-tempered54 3 2 1

Accepting54 3 2 1

Honest54 3 2 1

Compassionate54 3 2 1

Appreciative54 3 2 1

Courteous54 3 2 1

Respectful54 3 2 1

Patient54 3 2 1

Trustworthy54 3 2 1

Students are responsible for having five different persons complete this character survey. These people can be inside or outside of school (church members, social group coordinators, employers, etc.) Limit family members to one evaluation.

Please return this survey toDavid Adoff or Michael Chapin via interschool mail or 1005 Kriebel Mill Road, Eagleville, Pa. 19403postmarked no later thanSeptember 28, 2015. Any surveys postmarked after Septmeber 28thwill not be accepted.

Name (print)______Title______

Signature______Date______

Relationship to student______

Number of years you have known this student______

National Honor Society – Evaluation of Character

______(name) is in the process of applying for induction to the National Honor Society. Please complete this survey to give NHS a reflection of CHARACTER for the applicant. Thank you for your cooperation.

Would you describe this person as:

Very Strong Strong Average Below Average Minimal

Dependable54 3 2 1

Even-tempered54 3 2 1

Accepting54 3 2 1

Honest54 3 2 1

Compassionate54 3 2 1

Appreciative54 3 2 1

Courteous54 3 2 1

Respectful54 3 2 1

Patient54 3 2 1

Trustworthy54 3 2 1

Students are responsible for having five different persons complete this character survey. These people can be inside or outside of school (church members, social group coordinators, employers, etc.) Limit family members to one evaluation.

Please return this survey to David Adoff or Michael Chapin via interschool mail or 1005 Kriebel Mill Road, Eagleville, Pa. 19403 postmarked no later than September 28, 2015. Any surveys postmarked after September 28th will not be accepted.

Name (print)______Title______

Signature______Date______

Relationship to student______

Number of years you have known this student______

National Honor Society – Evaluation of Character

______(name) is in the process of applying for induction to the National Honor Society. Please complete this survey to give NHS a reflection of CHARACTER for the applicant. Thank you for your cooperation.

Would you describe this person as:

Very Strong Strong Average Below Average Minimal

Dependable54 3 2 1

Even-tempered54 3 2 1

Accepting54 3 2 1

Honest54 3 2 1

Compassionate54 3 2 1

Appreciative54 3 2 1

Courteous54 3 2 1

Respectful54 3 2 1

Patient54 3 2 1

Trustworthy54 3 2 1

Students are responsible for having five different persons complete this character survey. These people can be inside or outside of school (church members, social group coordinators, employers, etc.) Limit family members to one evaluation.

Please return this survey to David Adoff or Michael Chapin via interschool mail or 1005 Kriebel Mill Road, Eagleville, Pa. 19403 postmarked no later than September 28, 2015. Any surveys postmarked after September 28th will not be accepted.

Name (print)______Title______

Signature______Date______

Relationship to student______

Number of years you have known this student______

National Honor Society – Evaluation of Character

______(name) is in the process of applying for induction to the National Honor Society. Please complete this survey to give NHS a reflection of CHARACTER for the applicant. Thank you for your cooperation.

Would you describe this person as:

Very Strong Strong Average Below Average Minimal

Dependable54 3 2 1

Even-tempered54 3 2 1

Accepting54 3 2 1

Honest54 3 2 1

Compassionate54 3 2 1

Appreciative54 3 2 1

Courteous54 3 2 1

Respectful54 3 2 1

Patient54 3 2 1

Trustworthy54 3 2 1

Students are responsible for having five different persons complete this character survey. These people can be inside or outside of school (church members, social group coordinators, employers, etc.) Limit family members to one evaluation.

Please return this survey to David Adoff or Michael Chapin via interschool mail or 1005 Kriebel Mill Road, Eagleville, Pa. 19403 postmarked no later than September 28, 2015. Any surveys postmarked after September 28th will not be accepted.

Name (print)______Title______

Signature______Date______

Relationship to student______

Number of years you have known this student______

National Honor Society – Evaluation of Character

______(name) is in the process of applying for induction to the National Honor Society. Please complete this survey to give NHS a reflection of CHARACTER for the applicant. Thank you for your cooperation.

Would you describe this person as:

Very Strong Strong Average Below Average Minimal

Dependable54 3 2 1

Even-tempered54 3 2 1

Accepting54 3 2 1

Honest54 3 2 1

Compassionate54 3 2 1

Appreciative54 3 2 1

Courteous54 3 2 1

Respectful54 3 2 1

Patient54 3 2 1

Trustworthy54 3 2 1

Students are responsible for having five different persons complete this character survey. These people can be inside or outside of school (church members, social group coordinators, employers, etc.) Limit family members to one evaluation.

Please return this survey to David Adoff or Michael Chapin via interschool mail or 1005 Kriebel Mill Road, Eagleville, Pa. 19403 postmarked no later than September 28, 2015. Any surveys postmarked after September 28th will not be accepted.

Name (print)______Title______

Signature______Date______

Relationship to student______

Number of years you have known this student______

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