Newark High School Student Wall of Fame
Application Form
Applicant Name: ______
Eligibility: Senior with at least an 90 cumulative average. With the exception of athletic pins/letters, all areas of the application relate only to the high school career (grades 9-12).
Academic Average (after 15 quarters)Signature of School Counselor
Students wishing to be considered for selection must submit the following:
- Typed application
- Typed essay
- Applicant and parent/guardian signature
School Based Leadership: Examples include team captain, officer positions, and lead roles in musical or drama. Reelected positions and similar positions held over multiple years should be listed on separate lines. For example, Interact Club president for two years running should be listed on two separate lines.
Dates / Title / Contact Information of Supervisor/CoordinatorNotes:
Additional notes could include leadership that does not quite fit, but is worth mentioning.
School BasedExtracurricular Activities/School and Community Based Service: Similar activities/service participated in over multiple years should be listed on separate lines. For example, Youth to Youth for two years running should be listed on two separate lines. Only note service completed above and beyond any course or graduation requirement and sustained for 20+ hours.
Dates / Title / Contact Information of Supervisor/CoordinatorNotes:
Additional notes could include activities that do not quite fit, but are worth noting.
School Based Music/Sports/Recognition at BOCES: List in chronological order all your letters/pins/recognitions earned or anticipated* during your senior year.
Dates / Letter/Pin/Recognition*Noting something and then not earning it can lead to disqualification.
Athletic Director Signature: ______
Music/Choral Director Signature: ______
WTCC Principal Signature: ______
School Based Extended Course Work I
Gemini/FLCC credits earned or registered*:
Course / Credits / Grade*Noting something and then not taking/completing it can lead to disqualification.
School Based Extended Course Work II
AP courses completed*:
Subject / Course Grade*Noting something and then not taking/completing it can lead to disqualification.
AP tests completed*:
Subject / Test Score*For each test completed a credit of .1 will be added to the “Extended Coursework” rubric score.
Character I: Please detail your disciplinary referral history by briefly noting incidents that led you to receive a referral. Athletic and non-athletic code violations should be included in this account. Significant history in this area can lead to immediate disqualification from Wall of Fame candidacy:
Character II: Please describe each Script N citation you have received:
*For each Script N citation a credit of .05 will be added to the “Character” rubric score.
Essay: Type an essay double-spaced, size 12 font.
Provide a personal explanation of your legacy. Use school/community service as your guiding theme.
In the event you have received three or more referrals/code violations, your essay should conclude with adescription of how your legacy was shaped because of your work with those impacted by each violation.
Due to Mr. Roote by Friday, May 1 at 3:00 pm