The National Junior Beta Club ~ Rockfield Elementary
2012 - Information Sheet & Application for Prospective Members
What is the BETA CLUB?
The National Junior Beta Club is an honor organization that recognizes outstanding academic achievement,
promotes strong moral character and social responsibility, encourages service to others, fosters leadership skills,
and provides settings for you to develop strong interpersonal skills.
Who qualifies for membership in the Rockfield JUNIOR BETA CLUB?
Students who have earned all A’s and B’s in content areas, have an A in conduct, who also exemplify strong
character, and have maintained role model behavior throughout the school year (no administrative referrals or
periods in in-school, out-of-school, or bus suspension) are eligible to apply for membership in the Rockfield
Elementary Junior Beta Club.
What are the requirements of membership?
Each member must pay induction dues and participate in at least 10 hours of community service throughout the
school year. Students are strongly encouraged to participate in as many service projects as possible since this is
the key to leadership development within our organization. In order to attend the Beta Club Convention in late
February, students must have at least 8 of their 10 community service hours.
What are the dues for members?
There is a one-time fee of $20 collected prior to induction. This includes a $15 national induction fee, and $5
local dues. You may wish to explore the National Beta Club website at www.betaclub.org to learn more about
the benefits that are included in the induction fee.
How do I apply for membership?
If a student earns all A’s and B’s in content areas AND has earned an A in conduct in the first quarter of the
school year, he/she may complete the attached application form and ask two teachers to complete the attached
recommendation forms; the applicant should give at least one form to a core content teacher.
Applications must be given directly to Miss Helton no later than 3:15pm on FRIDAY, November 2, 2012.
Please make sure that recommendation forms have been given to your teachers PRIOR TO the due date!
How will I know I have been accepted into the Beta Club?
Invitations for accepted students will be distributed during the week of November 5-9. After invitations are
distributed, prospective inductees must return their intention sheet and dues to Mrs. Helton during by
November 30, 2012 . The Beta Club induction ceremony will be held in December 2012 in the Rockfield’s
gymnasium.
Rockfield National Junior Beta Club Student Application Form
Directions: Complete all sections - please print legibly. Write your name and recommending teacher names on
the next page and give the recommendation forms to your teachers as soon as possible; give your teachers
plenty of time to complete the form before the deadline! Please note that your completion of this form does
NOT guarantee an invitation to membership. Earning all A’s and B’s, having an exceptional discipline
records and excellent faculty recommendations are the critical criteria for membership.
SECTION 1 – STUDENT INFORMATION
Applicant’s Name:
Home Phone:
Current Grade Level:
Address:
Homeroom Teacher:
Parent/Guardian Name(s):
Parent/Guardian Cell Phone(s):
Parent/Guardian E-mail:
Name the two teachers who will be submitting recommendations on your behalf:
Recommending Teacher #1:
Recommending Teacher #2:
SECTION 2 – ACTIVITIES AND AWARDS
I recognize that you are in elementary school and your list of activities and awards may be short at this point in
your life; however, it is important for you to begin thinking about the importance of participating in activities
that will demonstrate to others that you have potential for success. These activities should demonstrate strong
moral character and scholarship, along with a service orientation, and leadership potential.

School Activities & Awards: List all school activities in which you have participated during elementary
and middle school. Include clubs, teams, musical groups, etc, and list major accomplishments in each. List
any school awards that you have received.

Community Activities & Awards: List other activities (not listed above) in which you have participated.
For example: religious groups, community athletic teams, non-school clubs such as Boy or Girl Scouts,
other community organizations, etc., and list major accomplishments/awards in each.
SECTION 3: STUDENT STATEMENT
Beta Club students must be committed to the “highest standards of moral character and social responsibility”
according to the National Beta Club creed. Define what you believe the phrase “highest standards of moral
character and social responsibility” should look like in a student; how do you exhibit those qualities?
SECTION 4: VERIFICATION
Student Verification:
I grant permission for Miss Helton to review my school report cards to verify my grades. I understand that upon
review of my application, teacher recommendations, and final report card, I MAY or MAY NOT be given an
invitation to join the Rockfield Junior Beta Club. I attest to the fact that I am a good role model to my peers and
have had no administrative referrals, or bus suspensions during my Rockfield career. I also understand that if I
wish to accept the invitation, that I must submit my intention sheet and $20 Beta Club dues to Miss Helton no
later than Friday, November 30, 2012 and that no exceptions will be made.
Student Signature:
Date:
Parent Verification:
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 my son/daughter MAY or MAY NOT receive an invitation to
join the Rockfield Junior Beta Club based upon the outlined criteria. If my student’s application is accepted and
he/she wishes to participate, he/she must submit the intention sheet and $20 Beta Club dues to Miss Helton no
later than Friday, November 30, 2012. I understand that no exceptions will be made for accepting these items
after the deadline.
Parent/Guardian Signature:
Date: