Potomac Falls National Social Science
Honor Society
Minimum Membership Requirements
 Minimum Cumulative GPA: 3.0
 Social Science Cumulative GPA: 3.0 (unweighted)
 Have completed at least 4 semesters of social science courses.
 Complete at least 6 semesters of social science courses before graduation.
 Have been enrolled at Potomac Falls for at least one semester.
 Be involved in activities that demonstrate civic engagement in the school or
community.
Applications Due by: October 15th
Page 1 of 6
Potomac Falls National Social Studies Honor Society
Student Membership Form
Date: _____________________
Directions: Please complete all sections. Please type or print. 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.
Student’s Name: ________________________________________________
Current Grade: ___________________
Address: __________________________________________________________________________________________
__________________________________________________________________________________________________
Telephone: ____________________________________
Email: ________________________________________
Can you be contacted via Facebook: Yes / No
List of Social Studies Courses taken to date:
Title of Course
Year Taken
Letter Grade
Received
Teacher
** Please attach a copy of your transcript with your application
Page 2 of 6
Student Activity Form
I. Extracurricular Activities
List all activities in which you have participated. Include non-service clubs, athletic teams, musical groups, etc. and major
accomplishments in each. Do not include service clubs in this section – you will do that in section III.
Grade
Activity
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12
Accomplishment
II. 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.
Grade
Activity
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12
Accomplishment
III. Service Activities & Community Service
List service activities and community service in which you have participated. These can be service projects done with a group, whether in or out of
school, or done as individual projects performing service. Generally speaking, service activities are those that are done for, or on behalf, of others
(not including immediate family members) for which no compensation (monetary or other) had been given. Please list the names of an adult
supervisor who can verify your participation (in the space provided below the activity.
Grade
Service or Community Activity / Supervisor
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12
Major Accomplishment
Hrs / Week
Page 3 of 6
IV. Additional Requirements
Please attach a written statement explaining your interest in the social sciences and why you are seeking
membership in the Potomac Falls National Social Studies Honor Society. Responses should be typed, singlespaced, and no more than one page in length.
Students must have a minimum of TWO adult sponsors who certify the student has met the criteria of scholarship,
leadership, service, and citizenship. One must be a social studies teacher. The other may be a teacher, school
administrator, coach, or activity/community service sponsor.
Reference #1: Social Studies Teacher: _________________________________ e-mail: __________________________
Reference #2: Other teacher reference: _______________________________
e-mail: __________________________
I understand that completing this form does not guarantee selection to Rho Kappa, and that the information presented
here is accurate.
______________________________________________________________
Student Signature
Student Name (printed) _____________________________________________
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.
______________________________________________________________
Parent Signature
Student Name (printed) _____________________________________________
Date: ______________
To be considered for selection to Rho Kappa, this form must be HANDED to Mr. Ackerman or Mr. Ewald. It
should not be left in a mailbox or given to another person. No late forms will be considered.
Page 4 of 6
Teacher Recommendation Form
Name of Student: _________________________
Name of Teacher: _________________________
On a scale from 1 to 5, please rate this student on the following categories. If you do not know the student
well enough to comment on a particular attribute, please choose “N/A” as your response.
Student is…
Not at all
A little
Sometimes
Mostly
Always
Responsible
1
2
3
4
5
Reliable
1
2
3
4
5
Trustworthy
1
2
3
4
5
Academically
motivated
1
2
3
4
5
A leader in the
classroom
1
2
3
4
5
Involved in the
school and/or
community
1
2
3
4
5
Creative and/or
innovative
1
2
3
4
5
Please provide any additional comments that may prove useful in the membership selection process.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Page 5 of 6
Teacher Recommendation Form
Name of Student: _________________________
Name of Teacher: _________________________
On a scale from 1 to 5, please rate this student on the following categories. If you do not know the student
well enough to comment on a particular attribute, please choose “N/A” as your response.
Student is…
Not at all
A little
Sometimes
Mostly
Always
Responsible
1
2
3
4
5
Reliable
1
2
3
4
5
Trustworthy
1
2
3
4
5
Academically
motivated
1
2
3
4
5
A leader in the
classroom
1
2
3
4
5
Involved in the
school and/or
community
1
2
3
4
5
Creative and/or
innovative
1
2
3
4
5
Please provide any additional comments that may prove useful in the membership selection process.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Page 6 of 6