Madeleine Dugger Andrews
National Junior Honor Society
Student Activity Form
The National Junior Honor Society (NJHS) recognizes students who excel academically,
demonstrate strong leadership, citizenship and character, and commit service to the
community. These five categories are based on the five pillars of the National Junior Honor
Society: scholarship, leadership, citizenship, service, and character. Take the time to
consider all you have done in these areas. Please complete all sections. Do not be modest,
as every bit of information will be used by the Andrews Middle School Faculty Council to
assist with the fair consideration of your candidacy during the selection process.
Completion and submission of this form does not guarantee selection. Please submit your
completed application to the front office no later than the due date indicated on the last page of this
packet. Late applications will not be considered. Should you have questions about this form,
please contact Ms. Abrimian, your chapter advisor, at nabrimian@medford.k12.ma.us.
Administrative Information:
Student Name
Side (A or B)
Homeroom Teacher
Room #
Student Activity Form (cont.)
Scholarship
A scholar displays a sincere desire to succeed academically and shows a love of learning. A
scholar also maintains a steady B or above grade average in all academics and has achieved the
honor roll every quarter.
Character
Your character is the combination of qualities that distinguishes you from another person. It is
your combined moral and ethical make-up. Your qualifications for this pillar should be explained in
the required personal letter.
The student of character:
 Takes criticism willingly and accepts recommendations graciously.
 Consistently exemplifies desirable qualities of behavior (cheerfulness, friendliness, poise,
stability).
 Upholds principles of morality and ethics.
 Cooperates by complying with school regulations concerning property, programs,
classrooms, halls, etc.
 Demonstrates the highest standards of honesty and reliability.
 Regularly shows courtesy, concern, and respect for others.
 Observes instructions and rules, is punctual, and responsible both inside and outside the
classroom.
 Has powers of concentration, self-discipline, and sustained attention as shown by
perseverance and application to studies.
 Manifests truthfulness in acknowledging obedience to rules, avoiding cheating in written
work, and showing unwillingness to profit by the mistakes of others.
 Creates a climate of kindness and hard work in the school.
Student Activity Form (cont.)
Citizenship
Citizenship is a concept of participation concerning your attitude, fairness, and respect for fellow
human beings. Good citizenship encompasses your behavior in and out of school. The student who
demonstrates citizenship understands the importance of civic involvement, has a high regard
for freedom, justice, and democracy, and demonstrates mature participation and responsibility
through involvement with such activities as scouting, community organizations, and school
clubs. It also includes your duties, rights, and privileges as a citizen of Andrews Middle School. For
example, this may entail your efforts to help make Andrews a better place. Please fill out the
following chart attesting to your citizenship while at Andrews Middle School. Add any comments
you feel are necessary to explain. (Any suspensions, write-ups, or infractions of behavior and
discipline code at school or in the community will lead to disqualification of candidacy.)
Grade
6-7th
Citizenship
Supervising Adult
(signature if possible)
and Phone Number
Comments (if any):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Student Activity Form (cont.)
Leadership
The NJHS tries to develop good leaders. A leader does the right thing without being asked. Your
leadership ability is shown by the “extra” activities you are involved in, whether you hold an office
or not. Please list activities in which you have participated (in school or outside of school
leadership positions) and note any major accomplishments in each. (You may include sports teams,
scouting, clubs, etc.) Only those positions in which you were responsible for directing or motivating
others should be included. Please include the signature and phone number of the adult responsible
for supervising your leadership in each position.
The student who exercises leadership:
 Is resourceful in proposing new problems, applying principles, and making suggestions
 Demonstrates initiative in promoting school activities
 Exercises positive 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; demonstrates reliability and dependability
 Is a leader in the classroom, at work, and in other school or community activities
 Is thoroughly dependable in any responsibility accepted
 Is willing to uphold scholarship and maintain a loyal school attitude
Grade
5-7th
Leadership Position
Activity/Organization
Supervising Adult
(signature if possible)
and phone number
Student Activity Form (cont.)
Service
List service activities in which you have participated. These can be individual or group service
projects done either in or out of school. Generally, service activities are those that are done for or
on behalf of others (not including immediate family members) for which no compensation
(monetary or otherwise) has been given. Please ask an adult supervisor or someone who can verify
your participation in each activity to sign on the appropriate line, and also list the estimated
number of hours you invested while performing this service. (You may submit your Volunteer
Service Log with the appropriate signatures if you have been keeping one in addition to filling out
the chart below.)
The student who serves:
 Volunteers and provides dependable and well organized assistance, is gladly available, and
is willing to sacrifice to offer assistance
 Works well with others and is willing to take on difficult or inconspicuous responsibilities
 Cheerfully and enthusiastically renders any requested service to the school
 Is willing to represent the class or school in inter-class and inter-scholastic competition
 Does committee and staff work without complaint
 Participates in some activity outside of school, for example, Girl Scouts, Boy Scouts, church
groups, or volunteer services for the elderly, poor, or disadvantaged
 Mentors persons in the community or students at other schools
 Shows courtesy by assisting visitors, teachers, and students
Grade
6-7th
Activity
Hours of Supervising Adult
(signature if
Service
possible) and
Phone Number
Student Activity Form (cont.)
Additional Activities
Other Student Activities: List all other activities (not listed in previous sections) in which you
have participated. Include clubs, teams, musical groups, etc., and any significant accomplishments
in each.
Grade
5-7th
Activity
Accomplishments
Work Experience, Recognition, and Awards: Though not a specific criterion for membership,
please list below any job experiences, honors, or recognition that you have received that support
your candidacy for membership in the National Junior Honor Society.
Grade
5-7th
Job, Recognition, or Award
Group or Activity
Hours Spent
on Activity
(if applicable)
Supervising Adult
(name and phone
number)
Student Activity Form (cont.)
National Junior Honor Society
Teacher Recommendation Form
(Print out this page and submit to main office by May 8th.)
This student is eligible for membership in the National Junior Honor Society (NJHS). Students must obtain
three signatures from 6th or 7th grade teachers. Two of the three recommendations must be from your major
subject teachers: math, ELA, science, social studies, and foreign language. (Only one may be a 6th grade
teacher.) *Candidates, please be considerate by requesting recommendations after school only.
Selection for membership is based on outstanding scholarship, citizenship, character, leadership, and
service. Once selected, members have the responsibility to continue to demonstrate these qualities.
If you would recommend the candidate, as you believe he/she exhibits qualities of scholarship,
citizenship, character, leadership, and service, please sign in the space below.
1. I recommend this candidate, without reservation, for membership in the NJHS.
______________________________________________________________________________________________________________________________
Teacher Signature
Print Name
Please write one or two sentences explaining why you believe this candidate should be nominated as a member of the NJHS:
2. I recommend this candidate, without reservation, for membership in the NJHS.
______________________________________________________________________________________________________________________________
Teacher Signature
Print Name
Please write one or two sentences explaining why you believe this candidate should be nominated as a member of the NJHS:
3. I recommend this candidate, without reservation, for membership in the NJHS.
______________________________________________________________________________________________________________________________
Teacher Signature
Print Name
Please write one or two sentences explaining why you believe this candidate should be nominated as a member of the NJHS:
Student Activity Form (cont.)
Candidate Personal Essay Guidelines
For your Personal Essay, you are asked to write 200-300 words explaining why the Faculty
Council of the Andrews Middle School National Honor Society should choose you to be a member of the NJHS.
Describe why you think you should become a member of NJHS, keeping in mind the five pillars. Explain how
you have exemplified each pillar throughout your middle school career thus far (5 th grade may be applied).
Follow the individualized paragraph directions below to help you in writing your essay.
Below you will find a description of qualities that are reflective of students in the National Junior Honor
Society. Explain on a separate piece of paper how you personally believe that you have exhibited each of these
four characteristics. Each area should be covered in a complete paragraph with the appropriate heading of
the topic being covered. Please be specific and provide details. Don’t be bashful when explaining your
accomplishments; be proud of all you have done.
1.
Why do you want to become a member of the National Junior Honor Society?
2.
Scholarship: Speak about your academic success and accomplishments as a middle school student.
3.
Participation & Leadership: Include all school clubs, teams, performance groups, and extracurricular
activities in which you are involved; also include any activities sponsored by community, church, or
other youth groups, and include any work experiences. Finally be sure to include your
accomplishments and achievements while participating in each of these activities. Emphasize your
leadership experience. Remember that you do not have to be in charge of an activity in order to
demonstrate leadership qualities.
4.
Citizenship & Character: Citizenship is your commitment to your city, state, and/or nation. Character
is who you are when no one is looking. Show that you demonstrate courtesy, concern, and respect
toward each and every individual, regardless of differences. A student with exceptional citizenship
and character consistently exemplifies the desirable qualities of cheerfulness, helpfulness,
friendliness, trustworthiness, and fairness.
5.
Service: Service is one of the main goals of the National Junior Honor Society. With this in mind
define what service means to you. In detail clarify the service you have already rendered and
volunteered your time to in your community. Then explain what service you would like the NJHS to
be involved in while you are a member. Be realistic and specific, keeping our school community in
mind. Show that you demonstrate a willingness to volunteer, to gladly take on tasks that benefit the
school and/or the community, and to assist others enthusiastically whenever called upon to do so.
6.
Why do you think you should be nominated as a member of the National Junior Honor Society?
-
Please type your essay in 12 point font.
Please keep your essay to approximately 1 page.
Proofread! Use proper grammar, punctuation, capitalization, and spelling!
Must be your original work.
-
Student Activity Form (cont.)
Please type your essay in the space provided below.
Student Activity Form (cont.)
Membership Requirements after Induction
 All members must complete 20 hours of community service (through school, church, or other organizations)
throughout their 8th grade year. (A service-hour sheet will be attached to acceptance letters once the
application process is complete.)
 Members must attend all meetings unless they make prior arrangements for another school function
(band, choir, drill team, etc.). Meetings are generally once a month on Tuesdays or Thursdays after school.
Additional meetings may be scheduled to support specific service projects or activities.
 Missed meetings must be made up by completing an additional half hour of service for each meeting missed.
Numerous missed meetings will result in the dismissal of membership.
 Students will be required to take part in Homework Club on assigned days (once every few months) to assist
AMS students who require tutoring or help on homework.
All members are expected to continue abiding by the Five Pillars of Society of NJHS throughout their 8 th grade
career. Failure to abide by the rules will result in termination of membership.
Important Dates:
Friday, April 17th
Monday, April 27th
Wednesday, April 29th
Friday, May 8th
May 8th – 23rd
May 25th – 29th
Thursday, June 11th
Students receive candidacy letters and parent acknowledgment
forms.
Students turn in parent/guardian acknowledgement forms to the
front office.
After having viewed the application on their own time, candidates
meet during RTI to discuss the application and candidacy/nomination
process. Candidates come prepared to ask questions (if any).
ALL components of the application are due: application (submitted
to andrews.njhs@medford.k12.ma.us), teacher recommendation
forms (printed copy to office), parent/student signature forms
(printed copy to office).
*Late applications will not be considered.
*All components of the application must be in the office by this due
date to be considered. This includes parent signature forms and
recommendations.
Andrews NJHS Faculty Council reviews applications and make their
nominations.
Candidates receive nomination/rejection letters.
Final nominees are inducted into the Andrews NJHS. Induction will
be held in the Andrews cafetorium at 6:30 pm.
Student Activity Form (cont.)
Candidate and Parent Signatures
(Print out this page and submit to main office by Friday, May 8th.)
Signatures: I understand that completing and submitting this form does not guarantee selection to
the Andrews Middle School Chapter of the National Junior Honor Society. I attest that the
information presented here is complete and accurate. If selected, I agree to abide by the standards
and guidelines of the chapter and to fulfill all of my membership obligations to the best of my
ability.
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.
Parent/Guardian Signature
Date
Parent/Guardian phone number(s)
Parent email address
We request this information so that we may notify you regarding important details.
Please complete this form and submit via Medford Gmail accounts to andrews.njhs@medford.k12.ma.us
by Friday, May 8th.
Late entries will not be considered
Andrews Middle School
3000 Mystic Valley Pkwy
Medford, Massachusetts 02155