National Honor Society, Xaverian Chapter
Candidate Form
Name:_______________________________________________________________
Community #: ________________________
Current Grade Level:
11
Student ID #: _____________________
12
Helpful hint: Do not be modest. Your application provides you the opportunity to sell yourself to the Faculty Council who will fairly
evaluate your qualifications for membership. Proudly make a case for yourself – focus on quality instead of quantity. If an activity
fits into more than one category, select the best fit. You cannot repeat any activity in more than one category. Complete each
section with care, adding more space to the Candidate Form where needed.
1. Leadership Experiences
List, in order of importance, all leadership experiences held in school, community, or work activities during your time at Good Counsel.
Emphasize those positions in which you were responsible for directing or motivating others. Include any experiences in which you
demonstrated characteristics of an effective leader. You should only include activities in which you are able to clearly explain how
you positively contributed to a team, club, organization or work environment. Examples: leader of an organized activity or function,
elected officer for student government, club chairperson, newspaper editor, work manager, etc...
List Leadership
Experiences
Year(s)
(9-12
Only)
Explain How You
became a member
and/or Attained the
Specific Leadership
Position
Describe Your Duties
and/or Responsibilities
Explain How You Contributed
in a Leadership Manner
2. Service Activities
List, in order of importance, service activities in which you have participated during your time at Good Counsel. Service is defined as
volunteer work with no monetary compensation OR school credit. <NOTE: The hours listed below must be above the Good Counsel
Service requirement.> Please list the name and phone number of an adult supervisor who can validate your service, and list the
number of hours you invested while performing this service.
Activity
Number of Hours
Completed
(above GC
requirement)
Explain Your Responsibilities and Contributions
Name AND Contact
Information of
Adult Sponsor
3. Recognition and Awards
Though not a specific criterion for membership, please list below any recognition or awards that you have received during your time
at Good Counsel that support your candidacy for membership in the Honor Society.
Academic Recognition and/or Awards
Year Given
(9-12 only)
4. Signatures
I am aware that only the service, activities and honors documented in this application will be considered by the Faculty Committee.
I understand that the completion of this form does not guarantee selection into the National Honor Society. If selected, I agree to accept
the responsibilities of membership as listed below:
1. I will participate in the formal induction ceremony on (date to be determined).
2. I will complete 7 hours of service (above the required school service hours) to Good Counsel each year of membership
through peer tutoring, assisting teachers in their classrooms and/or participating in NHS service-related projects.
3. I will maintain a 3.5 GPA each year of membership.
4. I will attend scheduled NHS meetings of the National Honor Society and check my Good Counsel e-mail on a regular basis.
5. I will adhere to Good Counsel’s code of conduct and be a role model for my peers.
I understand that my membership may be revoked if I do not meet the above obligations.
I attest that the information presented in this application is complete, accurate, and is my own work.
Student signature: _________________________________________________________ Date: ________________________
I have read the information provided by my son/daughter on this application and can verify that it is true, accurate, and complete.
Parent/Guardian Signature: _________________________________________________ Date:__________________________
NOTE: This letter may not be written by a
family member or a GC Faculty member.
National Honor Society, Xaverian Chapter
Character Reference Form
Thank you for assisting in the NHS membership process for __________________________________. NHS membership requires
leadership and character which can be difficult to evaluate. Listed below are some helpful examples of what NHS students are
expected to exhibit in terms of character and leadership:
Attributes a student of character may possess:
• Takes criticism willingly, accepts recommendations graciously, is punctual when called upon
• Possesses the Xaverian Values of simplicity, humility, compassion, zeal and trust
• Demonstrates the highest standards of honesty and integrity
• Manifests truthfulness in acknowledging obedience to rules
Attributes a leader may possess:
• Takes the initiative in activities and strives to train and aid others to attain common objectives
• Willingness to yield one’s personal interests for the interest of others
• Self-confidence and the ability to go forward when others hesitate
Please attach a letter of reference recommending the above student for membership into NHS based on his/her character and
leadership attributes. Character references that include specific anecdotal examples of how the student has demonstrated the
above criteria, while in high school, will be given the highest consideration.
Reference letters must be received no later than noon on Friday August 30, 2013.
Sincerely,
Nathalia Melamed (melamed@olgchs.org)
NHS Chapter Advisor
Please sign, seal and return your letter of reference to:
Our Lady of Good Counsel High School
Attn: Nathalia Melamed
17301 Old Vic Blvd
Olney, MD 20832
National Honor Society, Xavarian Chapter
National Honor Society, Xaverian Chapter
Candidate Essay Form
Please respond to the following questions in one typed page (standard font and margins.)
DO NOT INCLUDE YOUR NAME ON THE ESSAY – INSTEAD LIST YOUR STUDENT ID NUMBER IN THE HEADER.
It is essential that your student ID number be listed; otherwise it is impossible for the Faculty Council to match your profile and your
essay. Without either portion the profile is considered incomplete and will not be reviewed. When submitted, there will be a
separate box for Candidate Forms and Candidate Essays.
“The Xaverian Chapter of the National Honor Society emphasizes leadership and service. Citing at
least one anecdotal example, how have you demonstrated the Xaverian Values through leadership
and/or service? What impact will your membership in NHS have on the Good Counsel community?”
Checklist
o Candidate Form: completed and signed by you and a parent
o Candidate Essay: Typed, no more than one page with student ID in
the header, NOT your name.
o Character Reference Form: Please ensure that your reference letter
is received by no later than Friday, August 30, 2012.
o Willingness to complete additional service hours to school: Please
be aware that this is a requirement once accepted into NHS.
**Submit ALL components by NOON on 8/30/13**