Sandusky Junior/Senior High School
National Honor Society
Student Activity Information Form
Name:
Address:
City, State, Zip:
Grade:
Parents/Guardians:
The criteria for the selection to the National Honor Society are:
Scholarship
Character
Leadership
Service
This form is the authorized tool for demonstrating these qualities to the SHS/NHS Faculty Council for the
purpose of membership selection. Attendance and discipline records will also be considered in
membership determination.
Complete the online application found http://hs.sandusky.k12.mi.us/
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Use only the space provided, and please type
Write the essay
Ask three teachers to recommend you for NHS by filling out the brief teacher evaluation form
Make sure you and a parents and or guardians read, sign, and turn in the entire packet
See Mrs. Chambers in the Counseling office or Mrs. Nicol if you have questions
THE DEADLINE FOR TURNING IN THIS PACKET TO MRS. CHAMBERS IN THE COUNSELING OFFICE IS 3:00
P.M., Wednesday, MARCH 19, 2014 – NO LATE FORMS WILL BE ACCEPTED!
Signature Form
I have read the information provided and to the best of my knowledge have completed this packet
factually, correctly, and honestly. I understand that all information and forms are due in the Counseling
office by 3:00 P.M. on March 19, 2014. Returning this packet puts my name in consideration for
membership, but does not guarantee an invitation to become a member. I further understand that
failure to turn the application in by the deadline will waive the right to be considered for membership
this school year.
If selected to NHS, I will donate four hours of tutoring or community service each semester.
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 Sandusky High School
National Honor Society shall remain confidential from my child and myself, and I hereby waive and give
up any and all rights that I have under the Michigan Public Records Act, or any other statute, ordinance,
or law, to gain access to, or copies of, such records or materials.
Student Signature: ______________________________________________
Date: ______________
Signature of Father/Guardian: _____________________________________
Date: ______________
Signature of Mother/Guardian: _____________________________________
Date: ______________
TEACHER EVALUATION FORM – print three forms for three teachers
Student Name _________________________________ Teacher Name ______________________
Teachers: Thank you for filling out this recommendation to Sandusky High School’s chapter of National
Honor Society for the above named student. As established by the national chapter, in order to become
a member, a student must not only excel in scholarship, but also in leadership, character, and service.
We ask that you rank this student on these four areas. Please check all boxes that are appropriate.
Outstanding
Good
Fair
Poor
Unable to
Judge
Scholarship
Character
Leadership
Service
What comes to mind when you think of this student?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Is there anything else you would like us to know about this student? If you marked “poor” in the chart
above, please explain.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Thank you for your time. Please drop this confidential recommendation form to Mrs. Chambers in the
Counseling office BEFORE March 19, 2014.
EXTRACURRICULAR ACTIVITIES
(Please list past and present 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, etc.)
Activity
Description
Positions held
ACADEMIC HONORS AND LEADERSHIP ROLES
(Briefly describe all other scholastic distinctions or leadership honors you have won or earned
beginning with ninth grade, such as academic teams or class officer)
COMMUNITY SERVICE
(Include all activities undertaken which were done on behalf of others without any
compensation to you for performing the service.) Include why community service is important
to you.
OTHER ACTIVITIES, HOBBIES, WORK EXPERIENCE
PERSONAL STATEMENT
This personal statement is a very important part of this application in that it helps us 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 thoughts and express yourself. Use only the space
provided. This essay must be typed.
We know you are a successful student. Tell us more about who you are as a person – what makes you
different or unique?