Universal​ ​School
Extracurricular​ ​Activities​ ​Form
Information​ ​requested​ ​is​ ​needed​ ​for​ ​academic​ ​transcripts.​ ​Please​ ​make​ ​sure​ ​all​ ​the​ ​information​ ​is​ ​accurate.
Please​ ​print:
First​ ​name:
Middle​ ​Initial:
Last​ ​name:
Address:
City:​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​,​ ​Illinois
Zip​ ​Code:
Year​ ​of​ ​graduation:​ ​2020
Date​ ​of​ ​birth:​ ​ ​ ​ ​ ​ ​ ​ ​ ​/​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​/
Soc.​ ​Sec.​ ​#​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​-​ ​ ​ ​ ​ ​ ​ ​ ​ ​Parent/Guardian​ ​name:
​ ​ACT​ ​:
SAT:
CLUB
ID​ ​Club​ ​(Shelter,​ ​Food​ ​Pantry,
Interfaith​ ​Events)
Students​ ​for​ ​Humanitarian​ ​Aide
National​ ​Honor​ ​Society
Book​ ​Club
Student​ ​Council
I.T.​ ​Squad
Cancer​ ​Awareness​ ​Club
Drama​ ​Club
H-UNIT​ ​(School​ ​Spirit)
STEM​ ​Club
MUNUC​ ​(Model​ ​United​ ​Nations​ ​of
the​ ​University​ ​of​ ​Chicago)
Debka​ ​Troupe
VOLUNTEER​ ​WORK
Mosque​ ​Foundation
CIOGC​ ​(Council​ ​of​ ​Islamic
Organization​ ​of​ ​Greater​ ​Chicago)
Mosque​ ​Foundation​ ​Community
Center
Local​ ​Public​ ​Library
(Provide​ ​Name)
Palos​ ​Community​ ​Hospital
Christ​ ​Hospital
Zakat​ ​Foundation
AMP​ ​(American​ ​Muslims​ ​for
Palestine)
Universal​ ​Saturday​ ​School
Program
Sunday​ ​School​ ​Program
OFFICE/POSITION/TITLE
ADVISOR/COACH
CONTACT​ ​INFO
CHECK​ ​IF
PARTICIPANT
MAS-ICNA​ ​(Muslim​ ​American
Society-Islamic​ ​Society​ ​of​ ​North
America)
Sound​ ​Vision​ ​Events
Tutoring​ ​(Other​ ​than​ ​NHS
member)
Universal​ ​All​ ​School​ ​Program
(Other​ ​than​ ​NHS​ ​member)
Universal​ ​School​ ​Fun​ ​Fair
(Other​ ​than​ ​NHS​ ​member)
SPORTS
Basketball
Soccer
Wrestling
Baseball
Volleyball
Chess
COMPETITION
Lexicon
Quran
Arabic​ ​Spelling​ ​Bee
Mathletes
MIST​ ​(Muslim​ ​Interscholastic
Tournament)
WYSE​ ​(World​ ​Youth​ ​Science​ ​&
Engineering)
Regional​ ​Science​ ​Fair
State​ ​Science​ ​Fair
Islamic​ ​Knowledge​ ​Bowl
AWARDS
Honor​ ​Roll
High​ ​Honor​ ​Roll
School​ ​Science​ ​Fair
Regional​ ​Science​ ​Fair
State​ ​Science​ ​Fair
ADD​ ​ONLY
NO​ ​NEED​ ​TO​ ​ADD
TOP​ ​3​ ​PLACES
PARTICIPATION
Where
AWARDS
Appropriate
WYSE
Arabic​ ​Spelling​ ​Bee
Quran
Islamic​ ​Knowledge
MVP​ ​(Indicate​ ​Sport)
Athletics
Exemplary​ ​Behavior
OTHER
IMAD​ ​(Illinois​ ​Muslim​ ​Action
Day)
MYLS​ ​(Muslim​ ​Youth​ ​Leadership
Symposium)
International​ ​Fest
Election​ ​Judge
1.
2.
3.
4.
5.
IMPORTANT​ ​NOTE:
Abbreviations​ ​and​ ​Acronyms​ ​must​ ​be​ ​spelled​ ​out
Form​ ​must​ ​be​ ​filled​ ​out​ ​in​ ​BLUE​ ​or​ ​BLACK​ ​INK​ ​PEN
DO​ ​NOT​ ​submit​ ​form​ ​without​ ​SIGNATURES​ ​&​ ​CONTACT​ ​INFO​ ​or​ ​otherwise​ ​INCOMPLETE
MUST​ ​SUBMIT​ ​BY​ ​DEADLINE​ ​INDICATED​ ​ABOVE
For​ ​AWARDS​ ​Category,​ ​ONLY​ ​include​ ​SIGNIFICANT​ ​ones.​ ​Do​ ​NOT​ ​add​ ​PARTICIPATION​ ​Awards