Carbondale Community High School Chapter

NHS Student Candidate Submission Packet – SENIORS, CLASS OF 2018

Student Information:

Full Legal Name:

Full Address:

City:, Illinois Zip

Phone #:Graduation Year:

Student email address:

  • All completed submission packets must be submitted on or before Friday, December 1ST,2017, at 3:15 pm, in the Principal’s Office at CCHS.
  • All submission packets must be completed in typed form using the template link listed on ourTerrierNet website as follows: Students & Parents heading – Class of 2018or Class of 2019- Important documents – NHS Student Candidate Submission form.
  • Additional attachments that are not part of the submission packet will also be discarded.
  • If you have any questions or problems with this application, please contact Ms.Cissell in the Principal’s office. Do not rely on information from other sources or students, as it may not be correct.
  • Please make and keep a copy of this document for future/additional reference.

No exceptions will be made regarding the above deadline

I understand that completing this information form does not guarantee selection to NHS. I attest that the information presented here is complete and accurate. If selected, I agree to abide by the standards and guidelines of the chapter and to fulfill all of my membership obligations to the best of my ability. I wish to be considered for selection into Carbondale Community High School’s Chapter of the National Honor Society. I understand that the Faculty Council’s decisions are final, and its deliberations confidential. I agree to abide by the Faculty Council’s decision.

Print student nameStudent signatureDate

I understand that completing this information form does not guarantee selection to NHS, and 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/Guardian signature Date

NATIONAL HONOR SOCIETY OATH

I pledge myself to uphold the high purposes

Of the National Honor Society to which I have been selected.

I will be true to the principles for which it stands;

I will be loyal to my school, and will maintain and encourage

High standards of Scholarship, Service, Leadership and Character.

NATIONAL HONOR SOCIETY GUIDELINES:

Membership in the National Honor Society is one of the highest honors that can be awarded to a student. The NHS has worked hard to bring the accomplishments of outstanding students to the attention of parents, teachers, peers and community. Chapters across the nation strive to give practical meaning to the Society’s goals of scholarship, leadership, service and character.

These four ideals are the criteria which will be sued for selection to NHS. No student is inducted simply because of a high academic average. The National Honor Society strives to recognize the total, well-balanced student: one who excels in all of these areas.

Membership, however, is more than an honor; it carries with it more than certain privileges. It involves a responsibility and an obligation to demonstrate those outstanding qualities which were considered in your selection. The National Charter of the National Honor Society) the base organization is housed in Washington D.C.) mandates that those inducted into any local chapter of the National Honor Society must maintain an active membership. This is defined by Carbondale Community High Schools Constitution as punctual attendance in at least 80% of the meetings, and documented participation in both the ongoing service projects as well as some of the specific service activities announced throughout the year. In addition, the Carbondale Community High School NHS member must not violate the Code of Conduct, and must maintain a minimum 3.0 cumulative GPA.

NATIONAL HONOR SOCIETY CODE OF CONDUCT:

If I am elected to membership in NHS, I am aware that my conduct at both school-sponsored and non-school sponsored events should reflect exemplary behavior. I am aware that violations of the code of conduct could lead to warnings, assignment to probation and/or dismissal from NHS and dismissal without a warning for egregious behavior such as cheating, illegal activity, insubordination but not limited to such behavior. I am also aware that violations of the code of conduct will be forwarded to the faculty council chairperson per his/her review. Infractions of the code of conduct include but are not limited to the following examples:

Academic Infractions
Falling below a GPA of 3.0
Cheating on tests, quizzes, etc.
Plagiarizing from the work of another
Giving one’s intellectual property to another
for the purpose of cheating / Behavioral Infractions
Use of mood-altering substances, ex.: alcohol, illicit drugs
Any Infraction resulting in out of school suspension
(fighting, gross insubordination, threat to health/safety)
excessive tardies or absences without a doctors consent
disrespect toward faculty or staff
lying or excessive use of profanity or vulgarity
Behavior which interferes with the safety or educational
climate of the school

I have read the membership oath, guidelines and the Code of Conduct. My signature and my guardians’ signature indicate that if selected for membership, I will live up to the standards of the Carbondale Community High School Chapter of the National Honor Society.

______

Student SignatureParent/Guardian Signature

______

DateParent/Guardian Signature

Student Activity Profile

  1. School Activities
  • List all high school activities you have participated in, as an active member in good standing.
  • Include clubs, teams, music groups, plays, etc, including leadership positions held and accomplishments made in each. Examples include: Class officer, chairperson, team captain.
  • Briefly describe the activity.
  • Sponsor, advisor, or coach name must be listed and a signature is required. If the sponsor, advisor, or coach is no longer with CCHS, please indicate on the form. If you have transferred in to CCHS during high school, we will need contact phone #’s or emails for these individuals.
  • Additional School ActivitiesProfile sheet on page 7 of this template(if needed).

Activity, Club, or Team
Include description of involvement and leadership positions held. / Grade
9,10,
11,12 / Total
Hours
(academic year) / Sponsor/Advisor/Coach NameSIGNATURE
Contact cell:
Email:
9
10
11
12
9
10
11
12
9
10
11
12

TOTAL Activity hours:

  1. Community Activities and Service
  • List all community and/or service activities you have participated in for the betterment of the community during high school. Examples: Outside of school clubs, scouts, dance, Boys & Girls Club, Church groups, Habitat for Humanity, Special Olympics, coaching, tutoring, etc.
  • Include leadership positions held and accomplishments made in each.
  • Briefly describe the activity.
  • Sponsor, advisor, or coach name must be listed and a signature is required. If the sponsor, advisor, or coach is no longer available, please indicate on the form. If you have transferred in to CCHS during high school, we will need contact phone #’s or emails for these individuals.
  • Do not repeat participation already listed elsewhere in packet.
  • Do not list activities in which you’ve been paid or have received school credit or extra credit.
  • Additional Community Activities and Service sheet on page 8 of this template, if needed.

Organization or Service Group
Include clear description ofservice organization, purpose or mission,and community benefit. / Grade
9,10,
11,12 / Total
Hours
(Academic
Year) / Sponsor/Advisor/Coach
Name & SIGNATURE
Contact cell:
Email:
9
10
11
12
9
10
11
12
9
10
11
12

TOTAL Activity hours:

  1. Work Experience, Recognition, Awards & Honors
  • List below any job experiences, honors, or recognition you have received that may support your bid to be selected for National Honor Society.
  • Supervisor or sponsor name required. Contact phone number or email required.
  • Work experience may be paid or volunteer (working with family, babysitting family, etc.)
  • Please do not repeat any prior listed activity.
  • Additional Work Experience, Recognition, AwardsHonors sheet on page 9 of this template.

Employer, Award, or Recognition
*List the organization if applicable / Grade
9,10,
11,12 / Supervisor or Sponsor Name
*Contact phone number or email (required)
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12
  1. Essay Instructions

In an attached typed essay, not to exceed one page (double spaced, 12 font), explain why you should be selected for National Honor Society membership. The essay should give two examples of an activity, event, or involvement, which illustrates your character and leadership. The committee is especially interested in seeing demonstration of outstanding characters and concrete evidence that you have a commitment to something outside yourself – to other people or other causes. The essay should be specific and avoid generalities.

  1. Discipline

List and describe infraction(s)or disciplinary action(s) from your years at CCHS.

Please offer an explanation as to how it attests to your character. If not applicable, please put n/a.

END OF APPLICATION

  1. School Activities(Additional page).

Activity, Club, or Team
Include description of involvement and leadership positions held. / Grade
9,10,
11,12 / Total
Hours
(academic year) / Sponsor, Advisor, Coach NameSIGNATURE
Contact #
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12

Hours this page:

Hours (pg. 3)

TOTAL HOURS

  1. Community Activities and Service(Additional page)

Organization or Service Group
Include clear description of service organization, purpose or mission, and community benefit. / Grade
9,10,
11,12 / Total
Hours
(Academic
Year) / Sponsor/Advisor/Coach
Name & SIGNATURE
Contact cell:
Email:
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12

Hours this page:

Hours (pg. 4)

TOTAL HOURS

  1. Work Experience, Recognition, Awards & Honors(Additional page)

Employer, Award, or Recognition
*List the organization if applicable / Grade
9,10,
11,12 / Supervisor or Sponsor Name
*Contact phone number or email (required)
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12