MERCER ISLAND HIGH SCHOOL CHAPTER OF THE NATIONAL HONOR SOCIETY APPLICATION MUST BE E-MAILED TO MRS. GIFFORD –-

AND A HARD COPY BROUGHT TO HER ROOM-502

Student Name: ______Grade______

All students must have a 3.5 CUMMULATIVE Grade Point Average to be eligible.

Membership in the National Honor Society is one of the highest awards our school can extend to a student. In evaluating a student’s candidacy for the honor, all phases of the student’s school should be considered.

A student who qualifies for candidacy based on academic performance (GPA) is then evaluated and passed or rejected by the faculty on the basis of: Leadership, Character and Service.

The National Honor Society constitution calls for faculty vote by ballot with a majority required for membership. Please complete all sections of this application. Please type all information. Have a parent/guardian sign the application and return to Mrs. Gifford in Room 502 no later than 3:30 on Friday, April 26, 2012. ALSO: YOU MUST E-MAIL A COPY TO

Service Activities

List all volunteer activities done since March of 2011. These may be part of a group effort or may be done individually. Generally, these activities are done for others (not including family members) for which no compensation has been given. List the name and phone number of an adult who can verify your participation for each activity. Include hours spent for each activity. List when you participated and total hours of participation. Service hours must total 15 or more per year.

Activity and Description / Name/Phone of Adult / 10 / 11 / 12

Signature of one Adult who can verify your service for at least one activity (other than a family member). If you were a member of VOICE, you can use a copy of your certificate as verification. Signature can be faxed to Mrs. Gifford at (206)236-3358 or emailed to Mrs Gifford: Please put NHS in the subject line.

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Signature of Adult Verifying Service Date

If you are selected by the faculty committee, the induction will be held the evening of May 16, 2013.

Leadership

List all elected, appointed, or volunteer leadership positions that you have held in high school, community or work activities. Include positions to which you were directly responsible for organizing, motivating, or directing others. (i.e.: team captain, officer, student council member, editor, student director, manager, etc.) May include leadership roles you have taken on in classes or outside of school.

Activity / 9 / 10 / 11 / 12

àBriefly describe, in one page, on a separate sheet of paper, how you have demonstrated leadership qualities in the activities listed above. (VERY IMPORTANT)

Character

Give Names, Addresses and Phone numbers of three references, one of which must be a teacher/administrator at Mercer Island High School.

Name Address Phone Relation

Have you ever been subjected to disciplinary action by MIHS? □ YES □ NO

Are you currently on probation or suspension (academic or honor) at MIHS? □ YES □ NO

IF YOU ANSWERED “YES” TO ANY OF THE ABOVE, EXPLAIN FULLY ON A SEPARATE SHEET OF PAPER.

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I understand that completing this form does not guarantee selection to National Honor Society, and that the information presented here is accurate.

I have read the membership guidelines and fully understand that if offered admission I will uphold all responsibilities of the National Honor Society. Included in these responsibilities but not necessarily limited to are the following:

1) Regular attendance at meetings

2) Attendance at induction ceremonies for new members

3) Completion NHS sponsored community service hours

4) Participation in a school wide project(s)

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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.

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Parent or Guardian Signature Date