National Honor Society, Xaverian Chapter
Candidate Form
Name: ______________________________________________________________
________________
Student ID #:
Community #: ________________________
11
Current Grade Level:
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
include 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
4. Signatures
Year Awarded (9-12 only)
I am aware that only the service, activities and honors documented in this application will be considered by the Faculty
Council.
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 servicerelated 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 that 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 29, 2014.
Sincerely,
John Sullivan
sullivan2@olgchs.org
NHS Chapter Advisor
National Honor Society, Xaverian Chapter
Please sign, seal and return your letter of
reference to:
Our Lady of Good Counsel High School
Attn: John Sullivan
17301 Old Vic Blvd
Olney, MD 20832
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 29, 2014.
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 8/29/14**