The John C. Mills Chapter
Of the
Pleasant ValleyHigh School
National Honor Society
Application
Name:
Grade:
Date:
Introduction
The John C. Mills Chapter of the Pleasant Valley High School National Honor Society invites you to submit an application to aid in the selection process of future members. Membership in the National Honor Society is both an honor and a responsibility.
Directions
Please type orprint all sections in detail legibly! Do not be modest. Every bit of information can be used by the Faculty Council to assist with the selection process. List everything. However, completion of this form does not guarantee selection.
Please submit the application to the PVHS guidance office.
Late applications will NOT be accepted!
Membership Qualities
Students elected to membership must demonstrate the highest qualities of:
Scholarship
Leadership
Service
Character
Scholarship
Candidates eligible for election to this chapter must have a minimum scholarship average of 92.00% and not fall below an overall average of 85.00%. Candidates must be a member of the junior or senior class and have been in attendance at PleasantValleyHigh School for at least one school semester.
Based on the scholarship you have demonstrated, you are invited to submit an application that will be evaluated by an executive committee.
Leadership Positions and Awards –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. Please obtain the signature of an adult supervisor who can verify your participation in each activity/position.
School or Community Activity / Year / Hours/Week / Responsibilities / Accomplishments / Sponsor’s Signature, Printed Name & Phone #
9 / 10 / 11 / 12
Service Activities –List service activities in which you have participated. These can be service projects done with a group either in or out of school, or done as individual projects performing service. Include clubs, teams, musical groups, etc., and major accomplishments in each. Generally speaking, service activities are those which are done for or on behalf of others (not including immediate family members) for which no compensation (monetary or other) has been given. Examples of good community service include the following: Boy Scouts, Girl Scouts, church groups, etc. Please obtain the signature of an adult supervisor who can verify your participation in each activity.
School or Community Activity / Year / Hours/Week / Responsibilities / Accomplishments / Sponsor’s Signature, Printed Name & Phone #
9 / 10 / 11 / 12
Character –Examples of good character are difficult to illustrate, so please obtain the signature of three members of the community and/or PleasantValley faculty members who will attest to your good character. The community member may be the pastor of your church, your employer, or any other community member in good standing.
I believe that has shown qualities of good character; that is honest, reliable, responsible, courteous, cooperative, tolerant, and fair.
______/______/_____/_____
SignaturePrinted Name Title Date
______/______/_____/_____
SignaturePrinted Name Title Date
______/______/_____/_____
SignaturePrinted Name Title Date
On page seven, please obtain a detailed character reference from one of the above community or faculty members.
Please print your parents’ name(s), address(es), and phone number(s).
NAME:
ADDRESS:
CITY: STATE: ZIP CODE:
PHONE:
I understand that completing this form does NOT guarantee selection to N.H.S., and that the information presented here is accurate.
______/______/_____/_____
Student Signature Printed NameDate
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 Printed NameDate
Character Narrative–The mission of the John C. Mills Chapter of the Pleasant Valley High School National Honor Society is to create an enthusiasm for scholarship, to stimulate a desire to render service, to promote worthy leadership and to encourage the development of character in all students. These qualifications epitomize the National Honor Society member.
Using a three paragraph persuasive essay format following the Pennsylvania State Assessment Rubric, briefly state why you feel you deserve to become a member of the National Honor Society.(This persuasive essay may be typed on a separate sheet of paper).
______Student Signature
Character Recommendation –Perhaps the most difficult to quantify of the four requirements for membership in the National Honor Society is character. Since you know the applicant well, please address his or her character by considering the following: interpersonal skills, trust, dependability, enthusiasm, diligence, leadership, honesty, etc.(This character reference may be completed on a separate sheet of paper).
______/ ______Printed Name
______/ Signature
Title
(______)______- ______/ ______
Phone Number / Date
1