NORFOLK COLLEGIATE HEATH CHAPTER
OF THE NATIONAL JUNIOR HONOR SOCIETY

STUDENT INFORMATION FORM

This is not an application.

Directions: Please complete all sections (please type or print). Do not be modest. Every bit of information can be used by the Faculty Council to assist with the selection process. Completion of this form does not guarantee selection. Be sure to turn in your completed forms, complete with the required signatures, to Ms. Jill Archer by 3:30 p.m. Feb. 12, 2018.

I. Administrative Information

Name:______

II. Co-curricular Activities: List all activities in which you have participated since the sixth grade. Include clubs, teams, musical groups, etc., and major accomplishments in each.

Activity / 6th / 7th / 8th / Accomplishments

III. Leadership Positions: Any elected or appointed leadership positions held in school, community, or work activities. List the positions you held such as collaborative group leader, advisory representative, leader in a service project, SGA officer or representative, choice time leader, team representative or manager or project leader in your community.

Activity / 6th / 7th / 8th / Accomplishments

IV. Community Activities: List community activities in which you have participated and note any major accomplishments in each. These are activities you participated at school and outside of school. For example; sports teams, religious groups, clubs, Boy or Girl Scouts, or community art endeavors.

Activity / 6th / 7th / 8th / Major Accomplishments / Hours/Week


V. Work Experience, Recognition and Awards – List below any job experience, honor or recognition that you have received that support your bid to be selected for membership in the National Junior Honor Society. Work experience may be paid or volunteer.

Job Recognition or Award / 6th / 7th / 8th / Group or Activity/
Number of Hours Spent on Job or Volunteer Activity

I understand that completing this form does not guarantee selection to NJHS, and that the information present here is complete and 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

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