HARVEY CHAPTER OF THE

NATIONAL HONOR SOCIETY

Student application form

Due Friday, May 5th, 2017

As a part of the National Honor Society selection process you are being asked to complete the following student application form. Do not construe application completion with acceptance. This is merely a part of the selection process. Please type, and do not be modest. Every bit of information can be used by the faculty council to assist with the selection process.

I.  Administrative Information

Candidates Name / Phone Number
Parent’s name / Candidates grade
Address / Candidates birth date

II.  Co-Curricular Activities

  1. List all activities in which you have participated in during high school. Include clubs, musicals, groups etc. and major accomplishments in each. Do not list extra-curricular activities here such as sports.

Organization / year/years involved / Offices held / Major accomplishments and or responsibilities

III.  Extra-curricular Activities

A.  List all activities in which you have participated in during high school. Include all sports related activities major accomplishments in each. Do not list Co-curricular activities from part II here.

Activity/Sport / year/years involved / Major accomplishments and or responsibilities

IV.  Community Activities

A.  List all community activities in which you have participated in and note any major accomplishments in each. Theses should be activities outside of and not related to school in which you have participated in for the betterment of your community. For example: church groups, clubs sponsored outside of the school, boy or girl scouts, 4-H volunteer groups, or community art endeavors.

Community Activity or organization / year/ years involved / No. of hours / Major accomplishments and or responsibilities / Name of adult sponsor/supervisor

V.  Work Experience, Recognition, and Awards

A.  List below any job experiences, honors, or recognitions that you have received which support your bid to be selected for membership in the Harvey National Honor Society. Work experience may be paid or volunteer.

Employer/Job, or Volunteer group / year/ years involved / No. of hours / Major accomplishments and or responsibilities