Name
Address
City, State, Zip
Phone and Email
Grade
Do Not Write In This Space
Applicant Number
Total Points
Recommendation
The criteria for selection to the National Honor Society are:
You have met the standard of Scholarship. The standards of Character, Leadership, and Service will
now be reviewed in a variety of ways (this application packet, the Albert Lea High School faculty, and
the National Honor Society selection committee).
Complete the application form provided.
 Type your responses
 Use only the space provided
 Ask four teachers to fill out the brief evaluation form
 Make sure your and a parent/guardian read, sign, and then turn in the completed packet along
with the service hours recording sheet.
THE DEADLINE TO SUBMIT THE COMPLETED APPLICATION
TO THE MAIN OFFICE IS FRIDAY, DECEMBER 19, 2014.
SIGNATURE FORM
I have read and to the best of my knowledge have completed the attached application packet. I
understand that returning this application packet puts my name in consideration for membership, but
does not guarantee an invitation to become a member.
If elected to the National Honor Society, I will volunteer four (4) hours of tutoring each semester in
addition to my ten (10) community service hours.
Student Signature: ________________________________________
Date: _______________
I do hereby give my consent that any and all written records created, used or maintained by the school
in connection with the process of selection of candidates to become members of the Albert Lea National
Honor Society shall remain confidential from my child and myself, and I hereby waive and give up any and
all rights that I may have under the Minnesota Public Records Act, or any other statute, ordinance or
law to gain access to or copies of such records or materials.
Parent/Guardian Signature: __________________________________
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Date: _______________
EXTRACURRICULAR ACTIVITIES
Please list your extracurricular activities in the order of their interest to you. Include specific events
and/or major accomplishments such as musical instrument played, varsity letters earned, all-conference
selection, etc.
Activity
Description
Position Held
ACADEMIC HONORS AND LEADERSHIP AWARDS
Briefly describe any other scholastic distinctions or leadership honors you have earned beginning at the
9th grade.
Award
Description
COMMUNITY SERVICE
Include activities undertaken which were done on behalf of others without any material or monetary
compensation to you as the individual performing the act of service.
Service Project
Description
OTHER ACTIVITIES/HOBBIES/WORK EXPERIENCE
Activity
Description
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PERSONAL STATEMENT
This personal statement is a very important part of the application process. It helps the selection
committee become acquainted with you in ways different from courses, grades, test scores, and other
objective data. It enables you to demonstrate your ability to organize your thoughts and express
yourself. This essay must be typed. Use only the space provided.
We know you are a successful student. Tell us more about who you are as a person—what makes you
different or unique?
My signature below indicates that all information in my application is complete, factually accurate, and
honestly presented.
Student Signature: ___________________________________
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Date: _______________
Student Name: _____________________________
Teacher: _______________________
Teachers: Thank you for filling out this recommendation to Albert Lea High School’s National Honor
Society for the above-named student. As established by the national charter, in order to become a
member, a student must not only excel in scholarship, but also in character, leadership, and service. We
ask that you rank this student on these four areas. Please check the appropriate box for each area.
Outstanding
Good
Fair
Poor
Unable to Judge
Scholarship
Character
Leadership
Service
What comes to mind when you think of this student?
Is there anything you would like the selection committee to know about this student? If you marked
“poor” in the chart above, please explain why.
Student Name: _____________________________
Teacher: _______________________
Teachers: Thank you for filling out this recommendation to Albert Lea High School’s National Honor
Society for the above-named student. As established by the national charter, in order to become a
member, a student must not only excel in scholarship, but also in character, leadership, and service. We
ask that you rank this student on these four areas. Please check the appropriate box for each area.
Outstanding
Good
Fair
Poor
Unable to Judge
Scholarship
Character
Leadership
Service
What comes to mind when you think of this student?
Is there anything you would like the selection committee to know about this student? If you marked
“poor” in the chart above, please explain why.
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Student Name: _____________________________
Teacher: _______________________
Teachers: Thank you for filling out this recommendation to Albert Lea High School’s National Honor
Society for the above-named student. As established by the national charter, in order to become a
member, a student must not only excel in scholarship, but also in character, leadership, and service. We
ask that you rank this student on these four areas. Please check the appropriate box for each area.
Outstanding
Good
Fair
Poor
Unable to Judge
Scholarship
Character
Leadership
Service
What comes to mind when you think of this student?
Is there anything you would like the selection committee to know about this student? If you marked
“poor” in the chart above, please explain why.
Student Name: _____________________________
Teacher: _______________________
Teachers: Thank you for filling out this recommendation to Albert Lea High School’s National Honor
Society for the above-named student. As established by the national charter, in order to become a
member, a student must not only excel in scholarship, but also in character, leadership, and service. We
ask that you rank this student on these four areas. Please check the appropriate box for each area.
Outstanding
Good
Fair
Poor
Unable to Judge
Scholarship
Character
Leadership
Service
What comes to mind when you think of this student?
Is there anything you would like the selection committee to know about this student? If you marked
“poor” in the chart above, please explain why.
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