Sewanhaka Central High School District

Elmont Memorial High School

“A Nationally Recognized School of Excellence”

National Senior Honor Society -EMHSCandidate Information Form

Directions: Please complete all sections/pages of this form. Incomplete applications will not be considered. This information will be used in the selection process. Completion of this form does not guarantee selection/membership. FORM IS DUE BY 3:00 pm on Tuesday, October 13, 2015.

Part 1: Co-Curricular Activities

List three most recent activities you have been a participant in during school. Include clubs, teams, musical groups, etc., and explain how you were an asset to each.

Activity/Club/Team/Organization / Year(s) in which you Participated / Explain the ways in which you were an asset
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Part 2: Leadership Positions

List the most recent leadership positions held in school, your community, or work activities. For example, elected student representative, club officer, team captain, newspaper editor, work area manager, etc.

Leadership Position / Year(s) / Activity/Organization / Briefly explain your responsibilities
Ex / Co-Captain / Junior / JV Football / Organizing warm-up drills, communicating with coaches, etc.
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Part 3: Community Activities

List the most recent community activities (outside of school) in which you have participated and note any major accomplishments in each. For example, Boy/Girl Scouts, Church group, volunteer groups/service, clubs/teams sponsored outside of EMHS, etc.

Community Activity / Year(s) / Briefly explain how you participated and discuss any major accomplishments.
Ex / Church Choir / 2014- present / Attended all practices and church services; sang at holiday celebrations, etc.
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Part 4: Advanced/AP Courses

List the most recent Advanced/AP Courses taken within the past two years.

Course /Yr.
Ex: 10A English 2015 / Course /Yr.
Ex: 12AP Psychology current / Course /Yr.

Part 5: Recognition and Awards

List the most recent honors or recognition that you have received which will support your bid to be selected for membership. For example, High Honor Roll, Honor Roll, Spartan Award, Distinguished Achievement, Principal’s List, sports awards, service awards, special recognitions, etc.

Recognition/Award / Semester/Year(s) / Briefly explain how you earned this distinction.
Ex / Science Student of the Month / Spring 2015 / I studied, attended extra-help, tutored my peers, earned a 90% or above on exams.
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Part 6: Required Additional Information: TUTORING

1. Tutoring is an essential part of becoming a member. Please list the subject(s) you are comfortable tutoring other students in, as well as when you are available to tutor (before or after-school, lunch periods). All tutoring will be done at Elmont Memorial High School. You do not have to choose more than one subject.

Subject/Subjects
Example: Social Studies / Level
Example: Global / Availability
Example: After-school
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2. Current English Teacher: ______Period: ______

  1. Please have three teacher’s sign below indicating that they support your bid for membership/selection to the National Senior Honor Society. The teachers that you select should be able to testify to your academic commitment.

Teacher’s Name (print) / Teacher’s Signature
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**Please see me before the due date* below if you have any questions and/or concerns about this application form.

Please sign below. Your signature indicates that as a member of the EMHS Honor Society you acknowledge all the terms, conditions and requirements as they have been explained to you.

Print Name: ______Signature: ______

Parent/Guardian Name: ______Signature: ______

(Please print)

*This form must be submitted by Tuesday, October 13, 2015. APPLICATIONS WILL NOT BE ACCEPTED PAST 3:00 pm ON THIS DATE.

This form should be returned stapled to the top of your essay.