2022 2023 Patchogue-Medford High School NAVY (SEAL) LT MICHAEL P. MURPHY CAMPUS National Honor Society Assessment Thelma N. Temple Chapter STUDENT NAME: __________________________________________ GRADE LEVEL: ______ DIRECTIONS: Please read the following directions carefully! If you have received a letter at home notifying you of your academic eligibility, you must now complete the following assessment to be considered for National Honor Society membership. 1. Please complete all sections of this information form. All information must be typed into this assessment. No handwritten assessments will be accepted. 2. Once complete, print the assessment and obtain all necessary signatures and letters. 3. Be sure to sign the assessment. A parent/guardian must also sign the assessment. 4. Attach all pertinent letters for review by the National Honor Society committee. DO NOT have letters sent, e-mailed, or placed into an advisor’s mailbox separately. If these items are not attached to this assessment, they will be considered missing and will not be reviewed. 5. If any section of the assessment has been impacted by extenuating circumstances, please attach a personal statement of explanation. This statement must be typed. Statements will not be accepted after the due date of Wednesday, March 30, 2022. Important: If a signature is missing from the assessment, its absence should be explained in an attached letter. For this year, e-mail verifications from teachers/advisors/coaches will be accepted in place of signatures. These e-mails should not be a complete letter of recommendation. E-mails must be a 1-2 sentence statement of the applicant’s participation in the advisor/coach’s organization. E-mails must be printed and attached to this assessment for submission. 6. All assessments must be submitted to the main office by 2:00 pm on Wednesday, March 30, 2022. Late assessments will not be accepted under any circumstances. It is strongly suggested that this assessment be completed and submitted early. Additionally, Ms. Sweda-Abrescia is available during the application process to answer questions. Ms. Sweda-Abrescia is available before and after school in Room 370. You can also contact her at rsweda@pmschools.org. Please sign below: I understand that completion of this assessment does not guarantee membership in the National Honor Society. I understand that I will have no other opportunity this school year to submit material in support of my application for National Honor Society membership. Pending acceptance, I also agree to earn two community service credits and attend 50% of membership meetings to maintain National Honor Society membership before May 22, 2023. _____________________________________ _____________ Candidate Signature Date _____________________________________ _____________ Parent/Guardian Signature Date Check for Completion Before submitting this assessment, be sure that you ☐Obtained all required signatures. ☐Listed hours for each of your activities. ☐Obtained signed letters written on official letterhead from outside organizations. ☐Completed the required essay. ☐Reported any missing letters to Ms. Sweda-Abrescia before the assessment due date. ☐Included any necessary letters of extenuating circumstances. ☐Signed the assessment. ☐Had this assessment signed by your parent/guardian. PLEASE NOTE: Do not submit your assessment in binders or sheet protectors. Please make sure all assessment pages are secured by a staple or paper clip. ATTENTION: Additional letters and/or paperwork and/or any item(s) that have not been included will not be accepted after the assessment due date. Please be sure to carefully review your entire application and the check box items above prior to final submission. Part I: Leadership (Grades 9 – 12 only) List all elected or appointed leadership positions or other positions of responsibility held in school, community, or work activities. Only those positions in which you were responsible for directing or motivating others should be included (e.g., elected officer for a student club; team captain; community leader). The NHS Faculty Committee recognizes that leadership also exists outside of elected positions. Please explain in detail and verify any leadership not reflected in a formal position. All documented examples must be accompanied by a teacher, club advisor or administrative signature in ink. Any leadership position held in an activity outside of Patchogue-Medford High School must be accompanied by a signed letter on the organization’s letterhead. A supervising adult must explain how you demonstrated leadership in your organization, team, etc. All letters must include a phone number where the supervisor/writer of the letter can be reached. If the letter is not signed it will not be valid. Parents, fellow students, or relatives cannot write a letters. No letter will be considered unless it is on organization letterhead. It is expected that all students will obtain required letters from supervisors. It is understood that, due to extenuating circumstances, electronic letters may be submitted. These letters must be printed and attached to the assessment. EXAMPLE: Leadership Role Principal Leadership Council Officer Grade Level(s)/Year(s) and Hours of Participation 11th Grade (20 hours) Name of Activity/Organization and Description of Activities Supervising Adult’s Name & Contact E-mail 9th Grade Orientation Assisted with the planning and preparation of this event that included guest speakers and various workshops Dr. Rusielewicz RRusielewicz@pmschools.org Supervising Adult’s Signature and Date (or indicate if a letter is attached) Dr. Rusielewicz 4/1/22 LEADERSHIP Leadership Role Grade Level(s)/Year(s) and Hours of Participation Name of Activity/Organization and Description of Activities Supervising Adult’s Name & Contact Email Supervising Adult’s Signature and Date (or indicate if a letter is attached) Part 2: Other School Activities (Grades 9 – 12 only) List all other school-based activities (not noted in the previous Leadership section) in which you have participated in school. Include clubs, teams, musical groups, etc. Also include any significant accomplishments in each. Only include extracurricular activities. All documented examples must be accompanied by an advisor, coach or administrative signature in ink. Activity Grade(s) Accomplishments Advisor Advisor Signature Part 3: Service Activities (Grades 9 – 12 only) Service is generally considered to be those actions undertaken by a student which are done with or on behalf of others (not including immediate family members) without any direct financial or material compensation. The NHS Faculty Committee will review individual and group service projects done either in or out of school. All documented examples must be accompanied by a supervising adult’s signature in ink. Please ask the supervising adult to list the estimated hours you invested while performing this service. Also include the supervising adults e-mail address. Some examples that do NOT constitute Service include participation in sports, activities, drama productions, baby-sitting, part-time jobs, volunteering for family members or family businesses, playing in a school concert, playing on a team, or attending club meetings or team practice. Any service project completed outside of Patchogue-Medford High School must be accompanied by a signed letter on the organization’s letterhead. A supervising adult must explain your service project. The letter must include the estimated amount of hours invested in the service project. All letters must include a phone number where the supervisor/writer of the letter can be reached. If the letter is not signed it will not be valid. Parents, fellow students, or relatives cannot write a letters. No letter will be considered unless it is on organization letterhead. It is not necessary to provide letters from members of the Patchogue-Medford High School staff. If it expected that all students will obtain required letters from supervisors. It is understood that, due to extenuating circumstances, electronic letters may be submitted. These letters must be printed and attached to the assessment. EXAMPLE: Service Activity and Description Grade Level(s)/ Year(s) Name of Organization Supervising Adult’s Name & Contact E-mail Made lunches for the St. Francis de Sales soup kitchen on 4 occasions 11th Grade 12th Grade DECA Mrs. Meyer lmeyer@pmschools.org Supervising Adult’s Signature and Hourly Total (or indicate if a letter is attached) Mrs. Meyer approximately 8 hours SERVICE Activity and Description Years and/or Grade Level(s) Name of Organization Supervising Adult’s Name & Contact E-mail Supervising Adult’s Signature and Hourly Total (or indicate if a letter is attached) Part 4: Work Experience, Recognition and Awards (Grades 9 – 12) Though not a specific requirement for membership, listing job experiences, awards, or recognition that you have received will support candidacy for membership in the National Honor Society. Work experience may be paid or volunteer. School Year/Grade Recognition/Job/Award Organization, Group or Activity Hours Spent on Job or Activity (if applicable) Supervising Adult’s Name & Contact Information Part 5: Character Video Please submit a brief video addressing the following prompt: Discuss the character traits you believe are essential for a candidate for the National Honor Society. Explain how you have demonstrated these traits in the past (including this last school year). Your video statement should be in your own words and no longer than 3 minutes. To submit your video, you must visit the link e-mailed to you by Ms. Sweda. This link is in your school e-mail account. This video is a required element of your National Honor Society assessment.
