Tri-M Music Honor Society
Chapter 1164
Buena High School
Sierra Vista, Arizona

YEAR 2014

DIRECTIONS: Please complete all sections. Read and complete the entire form. Application must be typed. The committee will not review applications that are not typed, with all sections filled out. Applications are open to students in grades 9-12. Students will be chosen to become new members based on honors and involvement in musical activities.

I. INDIVIDUAL INFORMATION.

NAME
PARENT(S)/GUARDIAN(S) NAME
ADDRESS
TELEPHONE NUMBER
GRADE LEVEL
E-MAIL
INSTRUMENT/VOICE

PROCESSING CODE (advisor only): ______

APPLICATIONS DUE: 02/28/2014
INDUCTIONS: 03/05/2014

PROCESSING CODE (advisor only): ______

II. Music Participation—You MUST have been in a school music ensemble or class for at least one semester of the current school year.

List all music ensembles or classes in which you have participated in this current school year.

Music Participation

PROCESSING CODE (advisor only): ______

III. CO-CURRICULAR ACTIVITIES

Please list all the activities which you have participated in during high school. Include club, teams, musical groups, etc. Please list major accomplishments in each area. (Attach additional forms if needed)

ACTIVITY / 9 / 10 / 11 / 12 / ACCOMPLISHMENTS

PROCESSING CODE (advisor only): ______

IV. 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. (Attach additional forms if needed)

LEADERSHIP POSITION / ACTIVITY or ORGANIZATION

PROCESSING CODE (advisor only): ______

V. COMMUNITY & ACTIVITIES:

List any community activities in which you have participated and note any major accomplishment in each. These should be any activities outside of school in which you participated for the betterment of your community. For example: church groups, clubs sponsored outside the school, volunteer groups, or community art endeavors. (Attach additional forms if needed)

COMMUNITY or ACTIVITY / 9 / 10 / 11 / 12 / Dates / Major Accomplishment


PROCESSING CODE (advisor only): ______

VI. HONORS, ACHIEVEMNETS & AWARDS:

List below any musical honors, achievements or awards that you have received which support your request to be selected for membership in the Tri-M Honor Society. (Attach additional forms if needed)

Organization or Activity / Honors, achievements, or Awards


PROCESSING CODE (advisor only): ______

VII. CURRENT GRADES:

List your class hour, room number, and class title in the first three columns. Have your teachers initial the fourth column and enter your current grade in the last column.

Teachers, thank you for your assistance.

Period / Room # / Class Title / Teacher / Current Grade


PROCESSING CODE (advisor only): ______

VIII. GRADE VERIFICATION:

Please provide the following:

1)  Attach an unofficial grade transcript (from records office)

2)  Verified by: ______

IX. OBLIGATION STATEMENT

I understand that completing this form does not guarantee selection to Tri-M Music Honors Society, and that the information presented here is accurate.

______

Student Signature & Date

I have read the information provided by my son/daughter on this form and can verify that it is true, accurate and complete in its presentation.

______

Parent Signature & Date