National Junior Honor Society Application Form 2014-15
Koraes Elementary School
Name: __________________________
Grade:
7
8
(circle one)
______Yes, I would like to be considered for membership in the National Junior Honor Society
because I agree to participate in service projects and continue my enthusiasm for scholarship,
leadership, service, and character/citizenship.
If you checked yes, please complete this and the corresponding forms for each section listed below.
Please attach a typed statement (5-6 sentences) answering the following question: Why do I
want to be in the National Junior Honor Society?
*Return completed application to your homeroom teacher by May 13, 2015.
Applications will not be accepted after May 13, 2015.
_____________________________________________________________________________
I understand that completing this form does not guarantee selection to NJHS, and I verify that all
information presented here is complete and accurate.
Student Signature: __________________________ 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. I understand that completing this form does not guarantee
selection to NJHS.
Parent Signature: __________________________
Date: __________________
OPT OUT SECTION: Please complete this section if you do NOT wish to pursue membership in the NJHS at the
current time.
At the present time, (candidate name)___________________________, will be unable to fulfill the obligations and
requirements of the NJHS, or is not interested in becoming a member.
____________________________________
Student Signature
____________________________________________________
Parent Signature
Due May 13, 2015
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1. Scholarship: List honors or awards issued for academic excellence in the 6th- 8th grades. Honor
Roll and GPA to be verified by the middle school team.
Award/Honor
Date
Due May 13, 2015
2
2. Leadership: List all elected or appointed leadership positions at school or in the community
during 6th- 8th grades. Student leaders are those who are resourceful, good problem-solvers, ideacontributors, dependable, and persons who exemplify positive attitudes about life. Leadership
experiences can be drawn from mature participation and responsibility gained through involvement
with such activities as athletics, scouting, community organizations, and school clubs. Minimum of
two documented leadership roles are required.
Leadership Experience
Year(s) Participated
Due May 13, 2015
3
National Junior Honor Society Koraes Elementary School 11025 South Roberts Road Palos Hills, IL 60465
2. VERIFICATION OF LEADERSHIP ACTIVITIES
According to the National Junior Honor Society standards, the student who exercises leadership:
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Is resourceful in proposing new problems, applying principles, and making suggestions
Demonstrates initiative in promoting school activities
Exercises influence on peers in upholding school ideals
Contributes ideas that improve the civic life of the school
Is able to delegate responsibilities
Exemplifies positive attitudes
Inspires positive behavior in others
Demonstrates academic initiative
Successfully holds school offices or positions of responsibility; conducts business effectively and efficiently; and
demonstrates reliability and dependability
Is a leader in school or community activities
Is thoroughly dependable in any responsibility accepted
Is willing to uphold scholarship and maintain a loyal school attitude
_____________________________ is academically eligible for membership in the Koraes
Elementary School National Junior Honor Society. Membership, however, is also based on
leadership. We solicit your help in evaluating this student. Please indicate your information regarding
his/her leadership in: (indicate the name and/or nature of the activity you advise).
PART ONE: DESCRIPTION Please describe the role that the applicant played in the activity.
Explain what he/she exactly did to be considered a leader. (Use reverse side or another piece of
paper if necessary).
PART TWO: TIME/DURATION Please estimate the number of hours per week that the applicant has
functioned as a leader.
_____________ hours per week
Please estimate the duration of the leadership role or activity.
_____________ days or week (circle one)
_________ Total Hours
Activity Advisor’s Name (Please print) ___________________________________________
Activity Advisor’s Signature ___________________________________________________
Date _______________________________
Daytime Phone __________________
Email __________________________________________
Due May 13, 2015
4
3. Service: List all service activities in which you have participated in 6th – 8th grades. These can
be service projects with a group in or out of school or done as individual projects performing services.
Generally, these are done for or on behalf of others for no compensation such as church activities.
Minimum of 20 documented hours are required.
Service Activity
Date(s)
Due May 13, 2015
5
National Junior Honor Society Koraes Elementary School 11025 South Roberts Road Palos Hills, IL 60465
3. VERIFICATION OF SERVICE ACTIVITIES
__________________________ is academically eligible for membership in the Koraes Elementary
National Junior Honor Society. Membership, however, is also based on service. We solicit your help
in evaluating this student. Please indicate your information regarding his/her service in:
(Indicate the name and/or nature of the activity you advise).
PART ONE: DESCRIPTION Please list the activities that this student has performed that can be
considered as service to others. Be as explicit as possible concerning the student’s level of
involvement. (Use reverse side, or another piece of paper, if necessary).
PART TWO: TIME/DURATION Please estimate the number of hours per week that the applicant was
involved.
_____________ hours per week
Please estimate the duration of the service activity.
_____________ days or week (circle one)
_________ Total Hours
Activity Advisor’s Name (Please print) ___________________________________________
Activity Advisor’s Signature ___________________________________________________
Date _______________________________
Daytime Phone __________________
Email __________________________________________
Due May 13, 2015
6
4. Character/Citizenship: A person of character demonstrates the following six qualities:
trustworthiness, respect, responsibility, fairness, caring and citizenship. One way of demonstrating
good character is by remaining check free on report cards. Minimum of two referrals required.
____ I have demonstrated outstanding character by not having any behavior checks on my report
card.
Due May 13, 2015
7
National Junior Honor Society Koraes Elementary School 11025 South Roberts Road Palos Hills, IL 60465
4. VERIFICATION OF CHARACTER/CITIZENSHIP
CHARACTER/CITIZENSHIP Record for ______________________________________________
Definition: A person of character demonstrates the following:
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Meets promptly individual pledges and responsibilities both inside and outside the
classroom
Upholds the highest standards of honesty, reliability, fairness, and tolerance
Adheres to school rules and regulation (i.e. attendance, tardiness, truancy, academic
honesty, conduct, etc.)
Takes criticism willingly and accepts recommendations graciously
ADULT LEADER RECOMMENDATION
(Excluding all Koraes clergy, administrators, and any past or current teachers)
Based upon the above definition of character, I, ___________________________________,
(Adult Leader’s Printed Name)
support ________________________________________ for consideration for induction
(Student’s Printed Name)
into the National Junior Honor Society.
_________________________________________
_______________________
Adult Leader’s Signature
Date
Due May 13, 2015
8
National Junior Honor Society Application Check List
Page 1
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Student signature and date of application
Parent signature and date of application
Typed statement answering the question, “Why do I want to be in the National Junior Honor
Society.”
or
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Student and parent signature – opt out of application
Page 2
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List all honors or awards and dates received
Page 3
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List all leadership positions and years participated
Page(s) 4
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Verification of Leadership Activities - minimum of two (2) each signed and dated by activity
advisor
Number enclosed __________
Page 5
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List of service activities and dates – minimum of twenty (20) hours
Page(s) 6
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Verification of Service Activities – minimum of twenty (20) each signed and dated by activity
advisor
Number enclosed __________
Page 7
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Check the line if you have not received any behavior checks on report card
Page(s) 8
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Verification of Character/Citizenship – minimum of two (2) referrals from adult leader which
does not include Koraes clergy, administrators, or teachers.
Number enclosed __________
Due May 13, 2015
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