Page 1 of 5
Last Name, First Name
Class of ______
National Honor Society
Michael E. DeBakey High School for Health Professions
Membership Application 2012-2013
Membership Selection
The four guiding principles of the National Honor Society are scholarship, service, leadership,
and character. The Faculty Council of the DeBakey NHS will be considering all four of these
principles when deciding which students will receive the honor of selection into membership.
Selection into NHS requires a majority vote by the Faculty Council. Selected candidates will
become members at an induction ceremony in the fall semester.
Requirements BEFORE Consideration for Selection:
1. _____Insert a typed Header with your last name, first name, and graduating class
2. _____ Member of the junior or senior class for the school year of induction
3. _____ 3.7 or higher GPA (no curving)
4. _____
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Good Conduct Grades
No U’s
No office P’s
No more than 1 class P freshman year
No class P’s after freshman year
No more than 3 S’s after Freshman Year
No record of cheating
5. _____ Application Packet STAPLED
 TYPE YOUR COMPLETE INFORMATION ON TO THE FORM(Adjust font
size as needed)
 Your application will not be considered if it is handwritten (except signatures)
 All required signatures
 Both required short essays in MLA format. One page per essay
 STAPLED AND Turned in on time on or before Friday, May 25, 2012
The registrar and counselors will verify GPA’s, conduct grades
INFORMATION PACKETS ARE DUE IN MS. JOLIVET’S ROOM
NO LATER THAN 3:30 P.M. Friday, May 25, 2012
Late or incomplete application packets will not be considered.
(NO EXCEPTIONS)
NOTIFICATION OF SELECTION
Students selected for membership in the DeBakey NHS will be notified early in the fall semester.
Page 2 of 5
Last Name, First Name
Class of ______
Information Submitted for Selection Consideration 2012-2013
National Honor Society
Michael E. DeBakey High School for Health Professions
Type or print all information neatly and legibly in blue or black ink.
Last Name
(First)
Sex:
_male
Phone Numbers:
,
First Name
(Last)
_female
Age:
Year of Graduation
_
Home
Cell
E-mail address
Current Address
Apt #
(Street Number and Street Name)
City
,
TX
Parent/Guardian
Phone Numbers
Zip Code
relationship to you
Home #
Cell/Work #
Total Hours on record with Registrar Mr. Seaton ________________________ as of May 11, 2012
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All of the information I have submitted to the NHS is truthful and complete.
I understand the requirements for membership include but are not limited to the following:
maintaining a 3.7 or higher GPA, maintaining exceptional conduct at all times, participating
fully in NHS service projects, paying all dues, attending scheduled meetings, and behaving as
a positive role model for the rest of the student body and the community.
I understand that NHS membership is not a right or entitlement; it is an honor bestowed upon
selected students.
_________________________________________
Student’s Signature
I can verify that all of the information submitted to the NHS is accurate and complete. I
understand that NHS membership is not a right or entitlement, but an honor bestowed upon
selected students. I understand the commitment my son or daughter is making and the duties and
obligations that accompany NHS membership.
_________________________________________
Parent’s/Guardian’s Signature
Page 3 of 5
Last Name, First Name
Class of ______
Service during your High School years only
TYPED
List your three most significant community service activities or organizations. These may be individual or group projects, done in or out of
school. Report all service hours to the registrar with signatures. Be honest, but do not be modest. Briefly, describe what you did to make the
activity successful.
Service Activity or
Organization
Dates &
# of Hours
Sponsor’s Name and Phone #
1.
Date
Sponsor’s Name
2.
Hours
Date
Phone #
Sponsor’s Name
3.
Hours
Date
Phone #
Sponsor’s Name
Hours
Phone #
Your Accomplishments & Contributions
Leadership during your High School years only TYPED (EXCEPT SIGNATURES)
List your three most significant leadership community service activities. You could have been a leader with or without holding a formal office.
These examples may come from inside or outside of school. Be honest, but do not be modest. Briefly, describe what you did to help make the
activity or the organization successful.
Activity or
Organization
Dates
Involved &
# of Hours
Sponsor’s Name,
Phone #, & Signature
1.
Date
Name:
Phone #:
2.
Hours
Date
Signature:
Name:
Phone #:
3.
Hours
Date
Signature:
Name:
Phone #:
Hours
Signature:
Your Accomplishments & Contributions
& Any Office(s) Held
Page 4 of 5
Last Name, First Name
Class of ______
Clubs, Organizations, Hobbies, etc. during your High School years only TYPED
List your three most significant activities, clubs, organizations, or hobbies. These may come from inside or outside of school.
Sponsor’s Name
Activity or
Dates
Your Accomplishments & Contributions
Organization
Involved &
# of Hours Phone #
1.
Date
Sponsor’s Name
2.
Hours
Date
Phone #
Sponsor’s Name
3.
Hours
Date
Phone #
Sponsor’s Name
Hours
Phone #
Work and or Volunteer during your High School years only TYPED
List and briefly describe any jobs you have held recently.
Employer
Dates Involved &
Supervisor’s Name
Hours per week
& Phone #
1.
Date
Supervisor’s Name
2.
Hours
Date
Phone #
Supervisor’s Name
3.
Hours
Date
Phone #
Supervisor’s Name
Hours
Phone #
Your Job Responsibilities & Contributions
Page 5 of 5
Last Name, First Name
Class of ______
2 Short Essays
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Separate Pages
MLA
Title
Font Size 12
Times New Roman
Doubled Spaced
Correct paragraph indention (if more than one paragraph)
One inch margins
Five to eight sentences
First Person point-of-view
Format
Type your required responses to both of the following prompts using MLA format (12-point
font, double-spaced, one-inch margins). Each short essay should be only 5-8 sentences. Attach
your essays to this information packet. Use first person point-of-view.
Evaluation Criteria
Essays will be judged on the following:
 Meaningful content
 Scholarship:
-Grammar, punctuation, spelling, capitalization
-Organized, logical, coherent
-Varied and complex sentence structures
-Diction
-format
Service Prompt
Write a concise, 1-paragraph essay of 5-8 sentences explaining one significant lesson that you
have learned through a community service to others. This may be a lesson gained through
regular community service or informal service to others, such as caring for a handicapped sibling
or tutoring your friends in physics.
Leadership Prompt
Write a concise, 1-paragraph essay of 5-8 sentences explaining one example of how you have
demonstrated true leadership with a community service project. This is not about holding an
office. This is not about doing all of the work. This is about truly leading others to accomplish
something meaningful. You may have been a leader with a formal title and office, or you may have
been a leader without holding office. Stick to what you did, how you did it, and why you did it that
way. Do not include quotes and philosophies of others within your sentences.
“Optional”
Faculty Council will review the applications. If you feel Faculty Council needs information
regarding possible negative information about you, you may type a succinct explanation of the
mitigating circumstances behind the incident in question and attach it to your application.