Larkspur Middle School
National Junior Honor Society
Character, Service, Scholarship, Leadership, and Citizenship
Membership and Information Form
Name (Print):______Student ID #:______
Team: ______ Counselor: ______
CHECKLIST: Place a check for each item as it is completed. This checklist must be returned as the cover page of your completed application. APPLICATIONS SHOULD BE TYPED OR FILLED OUT IN BLUE OR BLACK INK ONLY. Electronic applications can be found at http://www.larkspurms.vbschools.com/.
***Having missing items on this checklist makes this an incomplete application and may result in not being considered for the NJHS***
SECTION I: Qualification for Membership
______Name & Student ID filled out
______Questions answered
______Student & Parent signature
SECTION II: Completed Activities
______Name & Student ID filled out
______At least one activity in each category of
LEADERSHIP, SERVICE, CHARACTER, and CITIZENSHIP
______Dates and signatures of contact persons
for each activity
SECTION III: Short Essay Response
______Name & Student ID written or typed on top of essay
______Typed or written in blue or black ink only
SECTION IV: Recommendation forms
______Name & Student ID filled out
______Form #1 given to CURRENT teachers to
be filled out and returned directly to Mrs. Wolford
______Form #2 given to an adult (non-family member) to be filled out and returned directly to Mrs. Wolford in a sealed envelope
Larkspur Middle School
National Junior Honor Society
Character, Service, Scholarship, Leadership, and Citizenship
Name (Print):______Student ID #:______
SECTION I: Qualification for Membership
Before you complete the application, you must be able to answer “yes” to the following questions. Please think seriously about each question.
1. Have you completed at least one full semester at Larkspur Middle School?
YES NO
2. Did you receive a CUMULATIVE 3.5 grade point average or higher for the FIRST SEMESTER this school year?
YES NO
3. Are you willing to attend National Junior Honor Society meetings a minimum of twice a month AFTER &/or BEFORE SCHOOL?
YES NO
4. Are you willing to donate at least ten service hours each semester for a total of 20 service hours during next school year?
YES NO
5. Do you understand that SCHOLARSHIP (your 3.5 or above GPA) is only one of five important requirements for membership in National Junior Honor Society, the other four being LEADERSHIP, SERVICE, CHARACTER, and CITIZENSHIP?
YES NO
6. Are you willing to acquire one letter of recommendation from all current core subject teachers and one letter from an adult who is NOT a family member?
YES NO
______
Student Signature Date
______
Parent Signature Date
Larkspur Middle School
National Junior Honor Society
Character, Service, Scholarship, Leadership, and Citizenship
Name (Print):______Student ID #:______
SECTION II: Completed Activities
Please list specific activities that represent the below listed qualities in you. Be specific. Include any awards that you may have received (such as Honor Roll, Perfect Attendance, Bug Roll, or Principals of American Citizenship). Some activities may be entered in more than one category. You must have AT LEAST ONE ACTIVITY FROM MIDDLE SCHOOL IN EVERY CATEGORY to be considered for membership. Attach a separate page if necessary.
CATEGORIES:
SCHOLARSHIP: In order to be eligible for the National Junior Honor Society, you must have a minimum 3.5 GPA.
LEADERSHIP: Taking the initiative to train and aid others to attain the same objective
ActivityDescription / Grade Level of Participation / Timeframe or Number of Hours of Participation / Printed Name and
Signature of Adult Adviser
Larkspur Middle School
National Junior Honor Society
Character, Service, Scholarship, Leadership, and Citizenship
Name (Print):______Student ID #:______
SECTION II: Completed Activities (continued)
SERVICE: Volunteering time, talent, and abilities to benefit those in need in school or in the community
ActivityDescription / Grade Level of Participation / Timeframe or Number of Hours of Participation / Printed Name and
Signature of Adult Adviser
CHARACTER: The force within each individual which distinguishes that person from others
ActivityDescription / Grade Level of Participation / Timeframe or Number of Hours of Participation / Printed Name and
Signature of Adult Adviser
Larkspur Middle School
National Junior Honor Society
Character, Service, Scholarship, Leadership, and Citizenship
Name (Print):______Student ID #:______
SECTION II: Completed Activities (continued)
CITIZENSHIP: The responsibilities each of us has to our home, school, or community.
ActivityDescription / Grade Level of Participation / Hours of Participation / Printed Name and
Signature of Adult Adviser
SECTION III: Short Essay Response
In 100 words or less, identify and describe the qualities that make you a stand out student and an ideal candidate for the NJHS. This must be completed on a separate sheet of paper with your name and Student ID on the top of the page- TYPED OR WRITTEN IN BLUE OR BLACK INK ONLY.
Larkspur Middle School
National Junior Honor Society
Character, Service, Scholarship, Leadership, and Citizenship
Name (Print):______Student ID #:______
SECTION IV: Recommendation #1 (CURRENT MATH TEACHER)
Teachers- Please complete this recommendation form and return directly to Michele Wolford’s mailbox no later than TUESDAY, MARCH 22nd.
Recommender’s name: ______Core Subject: ____Math____
1. Please evaluate the applicant to the best of your knowledge by checking the appropriate column.
CHARACTERISTIC Excellent Good Average Fair N/A
Integrity ______
Leadership Ability ______
Honesty ______
Responsibility ______
Punctuality ______
Hard Worker ______
Follows Directions ______
Works Well with Others ______
Dependability ______
Overall Citizenship ______
2. Please give a brief description of the applicant’s strengths. ______
______
3. Please state the applicant’s weaknesses. ______
______
4. Please list any additional comments that you have regarding the applicant.
______
______
5. I would recommend this student for the National Junior Honor Society (please circle one). STRONGLY AGREE AGREE DISAGRE
Larkspur Middle School
National Junior Honor Society
Character, Service, Scholarship, Leadership, and Citizenship
Name (Print):______Student ID #:______
SECTION IV: Recommendation #1 (CURRENT ENGLISH TEACHER)
Teachers- Please complete this recommendation form and return directly to Michele Wolford’s mailbox no later than TUESDAY, MARCH 22nd.
Recommender’s name: ______Core Subject: ___English_____
1. Please evaluate the applicant to the best of your knowledge by checking the appropriate column.
CHARACTERISTIC Excellent Good Average Fair N/A
Integrity ______
Leadership Ability ______
Honesty ______
Responsibility ______
Punctuality ______
Hard Worker ______
Follows Directions ______
Works Well with Others ______
Dependability ______
Overall Citizenship ______
2. Please give a brief description of the applicant’s strengths. ______
______
3. Please state the applicant’s weaknesses. ______
______
4. Please list any additional comments that you have regarding the applicant.
______
______
5. I would recommend this student for the National Junior Honor Society (please circle one). STRONGLY AGREE AGREE DISAGREE
Larkspur Middle School
National Junior Honor Society
Character, Service, Scholarship, Leadership, and Citizenship
Name (Print):______Student ID #:______
SECTION IV: Recommendation #1 (CURRENT SCIENCE TEACHER)
Teachers- Please complete this recommendation form and return directly to Michele Wolford’s mailbox no later than TUESDAY, MARCH 22nd.
Recommender’s name: ______Core Subject: ___Science_____
1. Please evaluate the applicant to the best of your knowledge by checking the appropriate column.
CHARACTERISTIC Excellent Good Average Fair N/A
Integrity ______
Leadership Ability ______
Honesty ______
Responsibility ______
Punctuality ______
Hard Worker ______
Follows Directions ______
Works Well with Others ______
Dependability ______
Overall Citizenship ______
2. Please give a brief description of the applicant’s strengths. ______
______
3. Please state the applicant’s weaknesses. ______
______
4. Please list any additional comments that you have regarding the applicant.
______
______
5. I would recommend this student for the National Junior Honor Society (please circle one). STRONGLY AGREE AGREE DISAGREE
Larkspur Middle School
National Junior Honor Society
Character, Service, Scholarship, Leadership, and Citizenship
Name (Print):______Student ID #:______
SECTION IV: Recommendation #1 (CURRENT SOCIAL STUDIES TEACHER)
Teachers- Please complete this recommendation form and return directly to Michele Wolford’s mailbox no later than TUESDAY, MARCH 22nd.
Recommender’s name: ______Core Subject: __Social Studies_
1. Please evaluate the applicant to the best of your knowledge by checking the appropriate column.
CHARACTERISTIC Excellent Good Average Fair N/A
Integrity ______
Leadership Ability ______
Honesty ______
Responsibility ______
Punctuality ______
Hard Worker ______
Follows Directions ______
Works Well with Others ______
Dependability ______
Overall Citizenship ______
2. Please give a brief description of the applicant’s strengths. ______
______
3. Please state the applicant’s weaknesses. ______
______
4. Please list any additional comments that you have regarding the applicant.
______
______
5. I would recommend this student for the National Junior Honor Society (please circle one). STRONGLY AGREE AGREE DISAGREE
Larkspur Middle School
National Junior Honor Society
Character, Service, Scholarship, Leadership, and Citizenship
Name (Print):______Student ID #:______
SECTION IV: Recommendation #2 (ANY ADULT- NON FAMILY MEMBER)
The NJHS looks for members who reflect outstanding accomplishments in the areas of scholarship, character, leadership, service, and citizenship. Please complete this recommendation form and place it in a sealed envelope and return it to the address below no later than TUESDAY, MARCH 22nd.
Michele Wolford, Larkspur Middle School
4696 Princess Anne Road
Virginia Beach, VA 23462
Recommender’s name: ______Contact Number: ______
Relationship to Applicant: ______
1. How long have you known the applicant? ______
2. Do you have regular contact with the applicant (please circle)? YES NO
If Yes, DAILY WEEKLY MONTHLY
3. Please evaluate the applicant to the best of your knowledge by checking the appropriate column.
CHARACTERISTIC Excellent Good Average Fair N/A
Integrity ______
Leadership Ability ______
Honesty ______
Responsibility ______
Punctuality ______
Hard Worker ______
Follows Directions ______
Works Well with Others ______
Dependability ______
Overall Citizenship ______
4. Please give a brief description of the applicant’s strengths. ______
______
5. Please state the applicant’s weaknesses. ______
______
6. Please list any additional comments that you have regarding the applicant.
______
______
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