Pettisville Chapter of the National Honor
Society
Student Activity Information Form
Remove all of these notes
to clean up this form.
This form must be done
on a computer. Please
save your file after you
have printed it and
turned it in.
Directions: Please complete all sections. Do not be modest. Every bit of
information can be used by the faculty council to assist with the selection
process. Completion of this form does not guarantee selection; it does give the
council more information to help make a favorable impression.
I.
Administrative information (Please type):
Name: _____________________________________
Grade: _________
Remove all these instructions in your final copy
and only keep the bold faced titles. Do this on all
of these pages.
II.
Co curricular Activities: List all activities in which you have participated
during high school. Include clubs, teams, musical groups, etc., and major
accomplishments or awards in each.
Activity
9th
10th
11th
12th
Accomplishments
Add or delete lines as
needed on each page.
Take the time to make
this look neat.
Remove all these instructions in your final copy.
III.
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.
Leadership
Position
9th
10th
11th
12th
Activity or Organization
Remove all these instructions in your final copy.
IV.
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 participate for the betterment of your
community. For example: church groups, clubs sponsored outside the school.
Boy or Girl Scouts, volunteer groups, or community art endeavors.
Community
Activity
9th
10th
11th
12th
No. of
hrs
per
week
Major accomplishments
Remove all these instructions in your final copy.
V.
Work Experience, Recognition, and Awards: List below any job
experience, honors, or recognition’s that you have received that support your bid
to be selected for membership in the National Honor Society. Work experience
may be in a paid or volunteer position.
Job Recognition or
Award
9th
10th
11th
12th
Job description or Volunteer
Organization description
I, ________________________, wish to be considered for membership in the
Pettisville Chapter of the National Honor Society. I understand that membership
is a privilege and not a right. Students are elected on the basis of Scholarship,
Leadership, Character, and Service. If elected I will participate in the activities
and service projects of the Pettisville Chapter.
Don’t forget to sign and
date this document.
__________________________________
signature
__________________
date
Please add page numbers.
VI.
Essay: The National Honor Society is both an academic honor society as
well as a service organization. Your academic, leadership, and service
credentials have awarded you the honor of being considered for membership.
The service projects of our chapter will be determined by the members of the
society. In the space below, please write an essay outlining a service project
that you feel would be of benefit to our school or community and that would also
be within the scope of our capabilities.
You can erase these instructions before typing
your essay. Please a standard font of at least 12
pts. and double space for ease of reading.
Use your best writing skills.