National Elementary Honor Society Chapter

Candidate Form

NEHS Selection Procedures

Kyrene Monte Vista

National Elementary Honor Society Chapter

Directions: THE STUDENT APPLICANT should complete all sections of this form. Type or print all information and submit it by the published deadline. All information will be used by the Faculty Council as they consider your candidacy during the selection process. Completion of this form does not guarantee selection. If you have questions about this form, please contact Mrs. Christine Hartland at 480-541-4527 or .

A. Student Information

Student’s Name: ______

Parent(s)/Guardian(s): ______

*Contact information: Please indicate your preferred method for receiving future notices about the results of the selection process.

Phone: ______

E-mail: ______

Mailing Address:

Street Address: ______

City/State/Zip: ______

*If you prefer to provide this contact information to the Chapter Adviser in person instead of providing it on this form, please do so at the time the form is turned in.

Grade: ______Teacher: ______

Student ID Number: ______Room Number: ______

~Please continue to complete your Candidate Form. ~

B. Responsibility

We are interested in learning how and where you have demonstrated being a responsible child, student, or citizen. Please fill in the following sections with as much information as possible relating to your life at school, home, and in the community. You may attach additional sheets if needed.

I. Responsibility Demonstrated at Home or with Family

Please list activities and chores that you have done to demonstrate your responsibilities at home. You can include such items as regular household chores, supervision of younger brothers or sisters, care or support for relatives or neighbors, family service projects in the community, etc.

*Age or Grade Level(s) / Home or Family Responsibilities
Example: grades 3-5 / Taking meals to my elderly grandmother every Saturday.

(*While only students in grades 4 and 5 are eligible for membership, the activities in which you participated prior to fourth grade can be provided on this form.)

II. Responsibility Demonstrated through Service Activities

List service activities in which you have participated. These can be individual or group service projects done in or out of school. Service activities are those that are done for or on behalf of others (not including immediate family members) for which no compensation (monetary or other) has been given. Please list the name of an adult supervisor who can verify your participation in each activity.

*Age or Grade Level(s) / Service Activity / Group or Organization / Supervising Adult
Example: grade 4 / Food drive contributor / 4th grade class / Mrs. Schneider

(*While only students in grades 4 and 5 are eligible for membership, the activities in which you participated prior to fourth grade can be provided on this form.)

III. Responsibility Demonstrated through Membership In and/or Recognition From Other Groups at School or in the Community

Please list all other school or community groups (not listed above) in which you currently belong or who have given you an award/recognition for an accomplishment. Include clubs, teams, musical groups, etc., and the name of the adult in charge of the group.

*Age or Grade Level(s) / Group or Organization / Supervising Adult
Example 1: 4 / Lion’s Roar Choir / Ms. Mulkey
Example 2: 5 / Safety Patrol Member / Mrs. Zimmerman

(*While only students in grades 4 and 5 are eligible for membership, the activities in which you participated prior to fourth grade can be provided on this form.)

IV. Responsibility Demonstrated Through Leadership Positions

Please list any elected or appointed leadership positions you have held in school or in the community. Only those positions in which you were responsible for directing or motivating others should be included, such as being an officer for the student body/class, or club, committee chairperson, team captain, scout leadership role, religious group role, or community service project leader. Please include the name of the adult/teacher responsible for supervising you in each leadership position.

*Age/Grade Level (s) / Leadership Position / Activity or Organization / Supervising Adult
Example: 3 / Class representative / Student Council / Mrs. Starr

(*While only students in grades 4 and 5 are eligible for membership, the activities in which you participated prior to fourth grade can be provided on this form.)

C. Character

Your character is the combination of qualities that distinguishes you from another person. It is your combined moral and ethical make-up. For this section of the application, you must obtain two different letters of recommendation from adults, attesting to your good character. You may not ask any teacher at Kyrene Monte Vista Elementary School, however, you may ask a former teacher from another school. Only one letter from someone related to you is allowed. You may ask neighbors, elementary teachers from previous schools, coaches, Scout leaders, clergy members, or other adults who know you well to write you a letter. Ask them to write a letter of recommendation stating how long they have known you, their relationship to you, and have them supply evidence of your good character. Give each person writing a letter for you an envelope so they can seal the letter. Please include these envelopes with your application materials.

D. Personal Essay

Your essay must be typed on a separate sheet of paper. Use only one sheet of paper typed double spaced and limited to one side. Include the essay with this application. Answer the prompt completely in order to receive full credit.

Prompt: Service is the main goal of the National Elementary Honor Society. With this in mind, first define what service means to you. Explain why you want to be part of the Kyrene Monte Vista NEHS chapter. Discuss the importance of school to you and the importance of contributing to our community. Conclude your essay by letting the readers know how you intend to make service a part of your life.

E. Signatures

Students-By signing below, I understand that completing this form does not guarantee selection into the National Elementary Honor Society chapter at Kyrene Monte Vista. The information presented here is complete and accurate. If selected, I agree to abide by the standards and guidelines of the chapter and to fulfill all of my membership obligations to the best of my ability.

Student’s Signature: ______Date: ______

If selected, you will receive an NEHS t-shirt. Please circle your t-shirt size: YS YM YL YXL AS AM

Parent(s)/Guardian(s): I/we have read the information provided by my son/daughter on this form and can verify that it is true, accurate, and complete.

Parent(s)/Guardian(s) Signature: ______Date: ______

Return your completed application to Mrs. Hartland in room 27 by December 16, 2014.

Thank you for completing this form, and on behalf of the faculty of Kyrene Monte Vista, congratulations on becoming a candidate for NEHS membership. Good luck! You will be notified of the selection results no later than January 8, 2014.

Important Dates Regarding Kyrene Monte Vista’s National Elementary Honor Society (KMVNEHS)
Application/Notification Dates
December 16, 2014 / NEHS Application due to Mrs. Hartland
January 9, 2015 / Date students and parents are notified of KMVNEHS selection of candidates.
January 13, 2015 / KMVNEHS Induction Ceremony: Monte Vista MPR Time: 6:30pm
Kyrene Monte Vista’s National Elementary Honor Society Meeting Dates
Location: Mrs. Hartland’s room (Room 27)
Wednesday, January 21, 2015 / 12:35-1:30pm / Student Meeting
Wednesday, February 18, 2015 / 12:35-1:30pm / Student Meeting
Wednesday, March 18, 2015 / 12:35-1:30pm / Student Meeting
Wednesday, April 15, 2015 / 12:35-1:30pm / Student Meeting
Wednesday, May 6, 2015 / 12:35-1:30pm / Student Meeting
Note: There will be five meetings with Mrs. Hartland, KMVNEHS Chapter Adviser, during the second semester
- Spring 2014. The expectation is that all student members are to attend all five meetings. However, one excused absence is allowed. Once notified of membership, should you have a conflict with meeting dates, please contact Mrs. Hartland.

If you have any questions regarding this form or NEHS, visit the NEHS website at contact your NEHS Chapter Adviser, Mrs. Christine Hartland at 480-541-4527 or .