BCMA National Junior Honor Society
Application Packet Cover Page
Please assemble your packet in the following order. Make sure your name is on
EVERY page! Staple in the upper left hand corner. Applications should be
delivered to Mrs Fogarty, Mrs. Scott or Ms. Wade .
o Application Packet Cover Page
o Student Activity Information Sheet
o Essay
o Teacher Recommendation Forms. Write your name on each form and submit to your
teachers. Your teacher will turn them into Mrs. Scott.
I understand that complete of this packet does not guarantee selection into the National
Junior Honor Society and I verify that all information present id both accurate and
complete.
Student Name (first & last; please print)
Grade
Student Signature
Date
*This Application Packet is due no later
than Friday, March 27, 2015*
National Junior Honor Society
Student Activity Information Sheet
Directions:




Please complete all section of this sheet
Please print clearly or type (you can download this form off the BCMA website if you
would like to type your answers)
Brag about yourself, don’t be modest!
If you have more items than space provided, please list only the most important. You can
use your essay portion for details and other accomplishments that you would also like to
share.
1. Scholarship
Neatly list all honors and awards earned for academic excellence in the last two years. You
may include honor roll, Duke Talent Search, Who’s Who of America, etc.
Honor or Award
Date
st
th
Example: A Honor Roll
1 Six Weeks of 6 grade
2. Co-Curricular Activities Neatly List all in school and community activities in which
you have participated in the past two years. Include clubs, teams, musical groups,
major accomplishments, etc.
Activity
Example: Recycling Club
Accomplishments
Made posters & collected recycling weekly
6th
Year
grade
3. Leadership Neatly list all leadership experiences you have had at school or in the
community in the last two years. Include positions in which you were responsible for
directing or motivating others. Such as elected position of student council, club officer,
you group, team captain, etc.
Leadership Role
Example: Student
Council Treasurer
Accomplishments
Raised $200 for Pennies for Patients
5th
Year
grade
4. Service Neatly list all service activities in which you have participate in the last two
years. These can be service projects with a group in or out of school, or done as an
individual. Generally these are done for or on the behalf of others (not including
immediate family) for no compensation (payment). Please include the name and
contact information of an adult who can verify your service activities. Please include
the name and contact information of an adult who can verify your service activities.
Service Activity,
Date/
Contact Person
Contact person phone
Organization, and
Number of
number or email
Location
Hours
Example: Helped to
11-07-12/ 6hrs
Joe Doe
joedoe@habitathouston.org
put tile on floors
National Junior Honor Society
Essay Question: Character and Citizenship
Think of three character traits that you possess. Examples could include bravery, perseverance,
punctuality, kindness, loyalty, cheerfulness, etc. Briefly explain how you have exhibited these
three characteristics and how they have benefited your school and community. Please provide a
few descriptive examples to support each trait (you can use your student activity sheet to help
you!) Next, explain how these character traits could serve your school and community if you are
inducted into the National Junior Honor Society.
Don’t be bashful when explaining your accomplishments; be proud of what you have done!
Guidelines:
 Essay Format ( four paragraphs)
 Introductory Paragraph
 Paragraph 2- Your 3 Character traits and supporting examples
 Paragraph 3- Connection to how these traits will benefit others asa NJHS member
 Conclusion Paragraph
 Please type your essay, double-spaced, in 12 point Times New Roman font
 Please keep your essay to approximately 250-500 words. This can be found under the
Review tab of Microsoft Word.
 Be sure to proof read your essay.
 Make sure your first and last name and grade level are in the top right corner of your
essay.
Character
is who you are when no one is looking
Citizenship
is your commitment to your school, neighborhood,
city, state, nation, world
Baylor College of Medicine Academy at Ryan Middle School
National Junior Honor Society
Teacher Evaluation
Name of Candidate:___________________________________________________
The student listed above meets the academic requirements for membership in the National
Junior Honor Society. In addition to completing the student application, students must
request three teacher recommendations, one of which must be a present core content
teacher. Selection for membership is determined by the faculty council and is based on
outstanding scholarship, citizenship, character, leadership, and service. Please take a few
moments to rate this student in each of the following five categories. The behaviors listed below
each trait are merely guidelines to help you determine if the student meets the criteria for each
one. Please use your own best judgment. Thank you for your time.
1- Never demonstrates this quality
2- Occasionally demonstrates this quality
3- Usually demonstrates this quality
4- Always demonstrates this quality
CHARACTER
Displays an understanding of right/wrong
Makes appropriate choices
Treats others with respect
1
2
3
4
SCHOLARSHIP
Displays Academic Effort
Appreciates value of education
Maintains high expectations of self
1
2
3
4
LEADERSHIP
Displays actions of role model
Leads by example
1
2
3
4
SERVICE
Displays willingness to help others
Assists those around them
Understands the value of serving others
1
2
3
4
CITIZENSHIP
Upholds school rules
Displays appropriate behavior
Appreciates spirit of community
1
2
3
4
Name of teacher: ______________________________ Grade and Subject:_______________________
Teacher Signature: ________________________________________________ Date________________
Please return form to Mrs. Scott by March 27, 2015. Forms are
not to be returned to students!