LAKEVILLE SOUTH CHAPTER OF THE
NATIONAL HONOR SOCIETY
STUDENT ACTIVITY INFORMATION FORM
*All forms must be turned in by____________________
Background Information:
Name_______________________Grade (check one)____11____12
Date of entry to LSHS___________ Telephone #________________
Activities: List activities that you have participated in during grades 9-12.
Examples Include clubs, teams, musical groups, community involvement, and
work experience.
ACTIVITY
YEAR (9-12)
I. Leadership Positions: List leadership positions held in school, community, or
work activities. List only positions in which you were directly responsible for
supervising or motivating others.
 Experiences could include being an officer, chairperson, captain,
manager, or leader
ACTIVITY
YEAR (9-12)
ACCOMPLISHMENTS
II. Service Activities: List all volunteer activities in school or community for
which no compensation (monetary or other) has been given. A pattern of service
to others must be demonstrated.
 It is important that you provide specific descriptions of each activity that
you provided on or for the behalf of others (not including immediate family
members).
SERVICE ACTIVITY
(With description)
YEAR
ADULT SUPERVISOR
(Name & telephone #)
III. Special Awards or Recognition- list special awards or recognition you
received.
AWARD/RECOGNITION
YEAR
SUPERVISOR/EMPLOYER
VI.Character: Honesty, Reliability, Adherence to Deadline Required
Signatures:
I understand that completing this form does not guarantee selection to NHS, and
the information presented here is complete, accurate, and truthful.
_____________________________________________________
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 Signature
Date
THE CRITERIA FOR MEMBERSHIP SELECTION IN THE NATIONAL HONOR
SOCIETY IS EQUALLY BASED UPON EXEMPLARY ACADEMIC
ACHIEVEMENT, CHARACTER, LEADERSHIP, AND SERVICE. YOU HAVE
ALREADY PROVEN YOUR EXEMPLARY ACADEMIC ACHIEVEMENT.
REQUIRED: NATIONAL HONOR SOCIETY ESSAY INFORMATION FORM:
PLEASE ANSWER THE FOLLOWING QUESTION:
QUESTION: CHOOSE ONE OF THE FOLLOWING NHS PILLARS
(CHARACTER, LEADERSHIP, SERVICE) AND DESCRIBE HOW YOU
EXEMPLIFY EXCELLENCE IN THIS AREA.
*Your answer should be a multi-paragraph essay using excellent writing
techniques.
*Your answer should be typed on a separate piece of paper