Application for National Honor Society Membership
Leggett High School
Directions: Please complete all sections. Please type or print neatly. Please do not be modest;
Faculty Council will consider all the information as part of the evaluation process. Completion of
this form does not guarantee selection.
Part I: Administrative Information
Last Name ____________________________ First Name _____________________________
Email Address: _________________________________________________________________
Home Address: _________________________________________________________________
City____________________________ State___________ Zip ___________________________
Home Phone: ________________________ Cell Phone _______________________ Text? Y/N
Parent Name ____________________________ Emergency Phone Number _________________
Part II: Extra-Curricular Activities
Directions: Please list all activities (school and non-school related) in which you have participated
during high school. Include clubs, teams, musical groups, sports, church activities, volunteer
groups, etc. Indicate in which grade(s) you participated in each activity mentioned in Column 2.
Activity
Grade
Advisor/Coach/Adult Supervisor
Contact Phone/Email
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
Part III: Leadership Positions
Directions: List all elected or appointed leadership positions held in school, community or work
activities. Include only those positions in which you were DIRECTLY RESPONSIBLE for directing or
motivating others. A student who exercises leadership is:

Resourceful in proposing new solutions, applying principles, and offering creative suggestions

Demonstrates initiative in promoting school activities

Exercises positive influence on peers in upholding school ideals

Contributes ideas that improve the civic life of the school

Delegates responsibilities to others

Exemplifies positive attitudes

Inspires positive behavior in others

Demonstrates academic initiative

Successfully holds school offices or positions of responsibility; conducts business effectively and
efficiently; demonstrates reliability and dependability

Is a leader in the classroom and in other school or community activities

Is willing to uphold scholarship and maintain a loyal school attitude
Activity
Grade
Accomplishment/Position Held
Advisor/Coach Name
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
Part IV: Service Activities
Service generally includes those actions undertaken by the student that are done with, or on behalf of
others without any direct financial or material compensation to the individual performing the service. In
considering service, the candidate’s contributions to the school, to classmates, and to the community are
reviewed. The student who performs service:

Volunteers and provides dependable and well-organized assistance, is gladly available, and is
willing to sacrifice to offer assistance.

Works well with others and is willing to take on difficult or inconspicuous responsibilities.

Cheerfully and enthusiastically renders any requested service to the school

Is willing to represent the class or school in inter-class and inter-scholastic competition

Does committee and staff work without complaint

Participates in some activity outside of school, for example: Girl Scouts, Boy Scouts, Church or
Temple groups, volunteer services for the elderly/poor/disadvantaged, etc.

Shows courtesy by assisting visitors, teachers, and students
Service
Grade
Advisor/Coach/Adult Supervisor
Contact Phone/Email
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
_______________________ 9 10 11 12
__________________________
________________
Part 5: Character
The National Honor Society is a member of the Character Counts! Coalition. A person of character
demonstrates the following six qualities: RESPECT, RESPONSIBILITY, TRUSTWORTHINESS,
FAIRNESS, CARING, CITIZENSHIP. The Faculty Council, which elects new National Honor Society
members, looks at the following characteristics of a student:

Takes criticism willingly and accepts recommendations graciously

Consistently exemplifies desirable qualities of behavior (I.E. Cheerfulness, friendliness, poise,
stability)

Upholds principles of morality and ethics

Complies with school regulations concerning property, programs, office, etc.

Demonstrates the highest standards of honesty and reliability

Regularly shows courtesy, concern, and respect for others

Observes instructions and rules, is punctual and faithful both inside/outside of the classroom

Has powers of concentration, self-discipline, and sustained attention as shown by perseverance and
application to studies

Manifests truthfulness in acknowledging obedience to rules, avoiding cheating in written work, and
showing willingness not to profit by mistakes of either self or others

Actively helps the school to eliminate the negative influences to the environment
Directions: Ask any of your Adult Supervisor/Teachers/Coaches to fill out the recommendation form for
Part IV. Recommendations must be turned in to the NHS Supervisor before selection of students can
begin.
I understand that completing this form does not guarantee selection into the National Honor Society and that the
information presented here is accurate. I also understand that the criteria presented for selection is the same criteria
that I would be expected to maintain as a member of the National Honor Society. I understand that if I am selected, I
will be responsible for maintaining my grade point average, paying my dues, meeting my community service
requirements and regularly attend scheduled meetings that might occur before or after school.
_____________________________________
Student Signature (MUST BE CURSIVE)
________________________________
Date
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.
____________________________
Signature of Parent/Guardian
_______________________
Relationship to Student
_____________________
Date
RECOMMENDER: PLEASE RETURN THIS PORTION ONLY, SEALED AND ADDRESSED TO:
Krystal Davis, National Honor Society Director, Leggett ISD, PO BOX 68, Leggett, Texas 77350
Student Name __________________________________________
How do you know this student?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
On a scale of 1 to 10, please rate this student in the following areas. Once you have rated them, please
make any remarks necessary to make an accurate selection. Please do not hesitate to give your honest
opinion of this student.
Leadership:
1
2
3
4
5
6
7
8
9
10
Remarks:______________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Service:
1
2
3
4
5
6
7
8
9
10
Remarks:______________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Character:
1
2
3
4
5
6
7
8
9
10
Remarks:______________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
General Comments:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
_____________________________ ______________________
Name (Please Print)
Print Name
________________________________
Email/Telephone Number
Guidelines for Faculty/Adult Evaluations Regarding Student Candidacy for NHS Membership
Please return for form to student as soon as possible in a sealed envelope bearing your signature across the seal. If
you feel competent to judge on only one or two of the qualities, do so. Not all students will be selected. Grade the
student on a scale of 1 to 10 according to the scale below:
1-3: weak in qualities listed below and not worthy of consideration
4-6: average in qualities listed below and not especially worthy of membership
7-8: superior in qualities listed below and worthy of consideration
9-10: excellent in qualities listed below and highly worthy of consideration
If you have any knowledge of any trait which would make a student an undesirable member of the society, please
explain under the Remarks. Please make comments freely, both pro and con, but only for character, leadership, and
service as scholarship has already been established.
Please consider the following criteria for your judgment, as reprinted from the National Honor Society Handbook:
Leadership:

Resourceful in proposing new solutions, applying principles, and offering creative suggestions

Demonstrates initiative in promoting school activities

Exercises positive influence on peers in upholding school ideals

Contributes ideas that improve the civic life of the school

Delegates responsibilities to others

Exemplifies positive attitudes

Inspires positive behavior in others

Demonstrates academic initiative

Successfully holds school offices or positions of responsibility; conducts business effectively and efficiently;
demonstrates reliability and dependability

Is a leader in the classroom and in other school or community activities

Is willing to uphold scholarship and maintain a loyal school attitude
Service:

Volunteers and provides dependable and well-organized assistance, is gladly available, and is willing to
sacrifice to offer assistance.

Works well with others and is willing to take on difficult or inconspicuous responsibilities.

Cheerfully and enthusiastically renders any requested service to the school

Is willing to represent the class or school in inter-class and inter-scholastic competition

Does committee and staff work without complaint

Participates in some activity outside of school, for example: Girl Scouts, Boy Scouts, Church or temple
groups, volunteer services for the elderly/poor/disadvantaged, etc.

Shows courtesy by assisting visitors, teachers, and students
Character:

Takes criticism willingly and accepts recommendations graciously

Consistently exemplifies desirable qualities of behavior (I.E. Cheerfulness, friendliness, poise, stability)

Upholds principles of morality and ethics

Complies with school regulations concerning property, programs, office, etc.

Demonstrates the highest standards of honesty and reliability

Regularly shows courtesy, concern, and respect for others

Observes instructions and rules, is punctual and faithful both inside/outside of the classroom

Has powers of concentration, self-discipline, and sustained attention as shown by perseverance and
application to studies

Manifests truthfulness in acknowledging obedience to rules, avoiding cheating in written work, and showing
willingness not to profit by mistakes of either self or others

Actively helps the school to eliminate the negative influences to the environment
Leggett High School National Honor Society
Eligibility:
National Honor Society membership is based on four core values: Scholarship, Service, Leadership,
and Character. A committee of teachers will make and/or take recommendations from school staff and
determine eligibility. Students will be notified when the selection process is complete.
Scholarship:



Students must maintain a minimum of 3.00 on a four point scale. One semester must have been
completed at Leggett ISD.
If student was a member in the previous school, a letter of transfer must be obtained from the
previous school’s chapter.
If member does not maintain the minimum grade point average, they will be put on Academic
Probation, and allowed one semester to regain minimum GPA status. If student does not regain
minimum GPA, membership will be terminated.
Service:



Students must contribute to the community and/or school in some way that has no monetary benefit
to the student.
Students are required to complete a minimum of 10 hours community service each semester.
Each hour must be kept track of, and signed off by an adult supervisor/coach/teacher. If the student
does not complete the required amount of hours, they will be put on Service probation until the
hours are completed. If the hours still are not met at the end of the school year, the student will not
be allowed to remain a member of the National Honor Society for the following year.
Service includes: volunteering at a hospital/nursing home; working as a volunteer teacher
aide/library before and/or after school (cannot be during school hours, unless a previous
arrangement is agreed upon by both teacher and National Honor Society Director); volunteer yard
work/housework for a non-family member; other approved community service projects as
suggested by the National Honor Society Director.
Leadership:


Students must present a positive role model to others, take initiative in group situations, and help to
direct or motivate others. Students are expected to take the responsibility of leadership seriously,
and not abuse the position.
Any legal offense (I.e. misdemeanor or felony, or other legal charges) will result in immediate
suspension of membership. If the student is found guilty, it will result in immediate termination of
membership.
Character:



Students must demonstrate respect for others, responsibility, self-worth, fairness, caring, and a desire to
learn. Students will also be trustworthy, and must honor their words/promises.
Students are required to pay $30.00 in dues each semester and are responsible for buying their cords/collars
for graduation. If student does not pay dues, they can be put on probation and will have their membership
terminated if non-payment continues.
Students must not receive more than one referral to the office in a semester. If the student receives more
than one referral to the office for any offense, student will be put on Leadership Probation, until the end of
that semester. If the student continues to be a discipline problem on school campus, their membership
will be terminated.