National Honor Society Application
Name
Address
Do Not Write in This Space
Character
1 2 3 4
Recommendations
City, State, Zip
Phone
E-mail
Grade
The criteria for selection to the National Honor Society are:
Scholarship
Character
Leadership
Service
Essay
Total Points
Leadership
Service
You have met the standard of scholarship. The standards of character, leadership and service will now be reviewed.
Please complete the application forms provided and turn in the packet based on your last name to Mrs. Liles, or
Mrs. Hatfield or Mrs. Murray by 3:15 PM on April 23, 2014. Please deliver the packet in person. Do not give to
another teacher, place in a mailbox, etc.
No late applications will be accepted.
The sponsors will accept completed applications on the following dates:
Tuesday, April 22—7:45-8:00 a.m. in the library
Wednesday, April 22—7:45-8:00 a.m. in the library
Wednesday, April 22—3:00-3:15 p.m. in the library
When the application packet is submitted, it will be considered complete. The sponsors are not responsible for
collecting any additional information including teacher recommendations.
After a packet has been submitted, it will be evaluated based on its content.
Directions:
1. Print and complete the application including the required essay. To maintain the format of the application, do
not add additional lines in any area.
2. Print the forms and secure signatures where necessary.
3. Ask four of your high school teachers to recommend you for the NHS by completing the evaluation forms. This
is part of your scoring, so select your teachers carefully. The teachers must place their recommendation in a
sealed envelope and sign across the seal. You are to provide the envelopes. Do not expect teachers to have these
on hand. You are NOT allowed to open the sealed envelope. The recommendation will be invalid if it has been
opened. These must be included in your packet at the time of submission to the sponsor.
4. Make sure that you and your parent read, sign and turn in the completed form.
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National Honor Society Application
SIGNATURES OF AGREEMENT
I have read and to the best of my knowledge have completed the attached information packet. I understand that
returning this information packet puts my name in consideration for membership but does not guarantee an invitation
to become a member.
If selected to NHS, I understand I must:
 Maintain a minimum 3.5 grade point average.
 Attend monthly meetings.
 Complete a minimum of 15 hours per year in NHS designated service projects.
 Pay the induction fee of $25.00 to cover the cost NHS regalia. This will be due after you have been
offered admission to the NRHS National Honor Society Chapter. It must be paid prior to your
induction.
 Abide by all school rules, local, state and federal laws.
 Attend induction practice and the induction ceremony each year of membership.
 Abide by the SPS Activities Code of Conduct.
I understand that failure in any of the above areas is grounds for warning or a dismissal hearing.
Student signature __________________________________________________________
I do hereby give my consent that any and all written records created, used or maintained
by the school in connection with the process of selection of candidates to become members of the National
Honor society shall remain confidential from my child and myself, and I hereby waive and give up any and all
rights that I may have under any other statute, ordinance or law to gain access to or copies of such records or
materials.
I understand the responsibilities for my child should he/she be accepted into the NHS.
Signature of Parent/Guardian _______________________________________________
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National Honor Society Application
EVIDENCE OF LEADERSHIP
Please list up to five activities for which you have been elected to office or assumed a formal leadership role (e.g. president,
coordinator, team/group leader, drum major, section leader, team captain, etc.) You may include leadership experiences from
school and community activities. Please have sponsors confirm your participation.
Organization
1.
2.
3.
4.
Position Held
Responsibilities
Activity Sponsor Signature _____________________________
Activity Sponsor Signature _____________________________
Activity Sponsor Signature _____________________________
Activity Sponsor Signature _____________________________
E-mail_____________________________
E-mail_____________________________
E-mail_____________________________
E-mail_____________________________
EVIDENCE OF SERVICE
List up to five SPECIFIC activities undertaken which were done on behalf of others without personal compensation. Secure sponsor
signatures. These service activities can involve school or community organizations. Please have sponsors confirm your participation.
Club or Organization
1.
2.
3.
4.
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Description of the
service activity
How did you contribute or
participate in this activity?
Sponsor Signature ___________________________
Sponsor Signature ___________________________
Sponsor Signature ___________________________
Sponsor Signature ___________________________
When did
this occur?
Approximate
number of hours
involved in this
service project
E-mail_______________________________
E-mail_______________________________
E-mail_______________________________
E-mail_______________________________
National Honor Society Application
STATEMENT OF CONDUCT
Have you ever been suspended from school or from athletic/activity participation due to violation of the Suffolk Schools
Code of Conduct? Yes No If yes, please provide a brief explanation of the event and the date of its occurrence. Also,
explain what you have learned from this experience and how you have changed your behavior
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National Honor Society Application
NATIONAL HONOR SOCIETY ESSAY
The essay provides a student the opportunity to express the meaning of character and the value of the four criteria in a manner that
cannot be accomplished through a simple information sheet.
You may choose to answer one of the following quotations and interpret its meaning as it relates to your interest in the National Honor
Society. In addition, explain how you have demonstrated this characteristic in one of the following ways: your personal life, an
academic environment, or in extracurricular activities. Your response should be placed in the space provided below. Your essay
should not exceed 350 words and must be in your original words.
1. “The hardest obstacle to overcome in any leadership position is getting past the apathy to get people involved in the process
to get things done…The greatest enemy to accomplishment is apathy.”-Nyron Burke, age 17
2. “The pace of today’s world creates stress which can be detrimental; good time management and self-care is critical. The
ability to prioritize and balance is essential.”
3. “Taking responsibility for starting a task or project without being asked is critical and expected today; these are the people
who will stand out…”
Please keep in mind that you are expected to produce a multi-paragraph FORMAL essay that will be scored for content, organization,
grammar and mechanic on the Advanced Placement Writing Rubric (AP Literature). A one paragraph response will not receive a high
score. Your numerical score on the essay will be part of the judging for admissions.
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National Honor Society Application
TEACHER RECOMMENDATION
Student: Print four copies and give them to four high school teachers who have consented to recommend you.
You are responsible for collecting the recommendation from each teacher and including each envelope with your
completed application.
Confidentiality Release
I understand that the contents of this recommendation will not be shared with me.
Student Signature ____________________________________________________________________________
Student Name __________________________________ Teacher Name _________________________________
Please print.
Please print.
Teachers: Thank you for filling in this recommendation for the above named student for selection to the National Honor
Society. As established by the national charter, in order to become a member, a student must not only excel in scholarship,
but also in leadership, character and service.
We ask that you rate this student on these four areas. Please place a check in the box that is appropriate. Your comments
will be kept confidential. Do not fill in this form unless the student has signed the release statement at the top of the form.
Please note that your ratings will be computed as part of the student’s application.
Please place in an envelope (provided by the student), seal the envelope, and sign across the seal. The student is
responsible for collecting the sealed envelope from you and including it with the completed application.
Outstanding
Good
Fair
Poor
Unable to judge
Scholarship
Character
Leadership
Service
What comes to mind when you think of this student?
_________________________________________________________________________________________
_________________________________________________________________________________________
Is there anything else you would like us to know about this student? If you marked “poor” in the chart above- please
explain.
_________________________________________________________________________________________
_________________________________________________________________________________________
Teacher Signature: ______________________________________
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