Name: ______
Student Activity Information Form
Please complete all sections in blue or black ink, or typed. An application can be found on the SHS website under For Students. Do not be modest. Every bit of information can be used by the Faculty Committee to assist with the selection process. If you feel that an explanation of any of these roles is necessary, please attach a paragraph describing your activity or participation. LATE APPLICATIONS WILL NOT BE ACCEPTED!
Co-curricular Activities
List all activities in which you have participated during high school. Include clubs, teams, musical groups, etc., and major accomplishments in each. Check off the grade year(s) of involvement. Only check the 12 box if you are sure that you will be involved in the activity next year.
Activity / 9 / 10 / 11 / 12 / Accomplishments / Contact information(name, email, or phone) / Signature of advisor
Activity / 9 / 10 / 11 / 12 / Accomplishments / Contact information
(name, email, or phone) / Signature of advisor
Leadership Positions
List all elected or appointed leadership positions held in school, community, or work activities. Only those positions in which you were directly responsible for directing or motivating others should be included. For example: elected student body, class, or club officer; committee chairperson; team captain; newspaper editor; work area manager; or community leader.
Position / 9 / 10 / 11 / 12 / Activity or Organization / Contact information(name, email, or phone) / Signature of advisor
Leadership Positions
The Faculty Committee realizes that, as a junior, it may be difficult to provide concrete examples of leadership positions at this time. Therefore, please write a brief description (below) that best exemplifies the qualities that you possess, that make you a good leader; and three concrete examples that demonstrate your leadership characteristics.
______
______
Community Activities
List community activities in which you have participated and note any major accomplishment in each. These should be any activities outside of school in which you participated for the betterment of the community. A minimum of 25 hours should be documented. For example: church groups, clubs sponsored outside the school, Boy or Girl Scouts, volunteer, or community art endeavors.
Activity(description, if necessary) / 9 / 10 / 11 / 12 / List hours completed
(per week, month, season; or total) / Contact information
(name, email, or phone) / Signature of advisor
Activity
(description, if necessary) / 9 / 10 / 11 / 12 / List hours completed
(per week, month, season; or total) / Contact information
(name, email, or phone) / Signature of advisor
Work experience, recognition, and awards
List below any job experiences, honors, or recognition that you have received which support your bid to be selected for membership. Work experience may be paid or volunteer.
Job, Recognition,or Award / 9 / 10 / 11 / 12 / Group or Activity/
Number of hours spent on job
or volunteer activity / Contact information
(name, email, or phone) / Signature of advisor