Name:
First Period Teacher (A and B days):
Grade:
Room:
English Teacher: Room:
1. Please list any school-related activities you have been involved in during your high school years and any leadership positions you have held.
2. Please list any work experience you have had during your high school years.
3. Is there any other information you believe would be helpful in evaluating your candidacy? If so, please explain.
4. In an attached essay, please describe an incident in your life that exemplifies one of the following character traits:
Scholarship, leadership, service or character. (Remember, the essay will be reviewed by an English teacher on the Faculty Council and other members of the Faculty Council. It’s not just what you write, but how well you write it.)
I do hereby declare that this information, to the best of my knowledge, is true, accurate, and verifiable. If accepted into the National Honor Society, I agree to follow the rules of the organization and will continue to live up to its standards.
Signature of Applicant Date
Signature of Parent Date

Community Service Verification Sheet is due at the same time as the application.
As you know, the National Honor Society requires that you have at least twenty hours of recent community service completed before being considered for induction into the Owl’s Head Chapter of NHS. Please give a brief description of how you completed your hours below with a signature and a
phone number and or e-mail address of the adult who supervised your service. These hours should have been completed after July 1, nothing from previous school years.
Remember:
• You cannot ‘double dip’ for your community service hours, that is:
1. Doing something for hours you needed to complete for confirmation and also counting those hours as your 20 hours for
NHS is not acceptable.
2. Doing a bottle and can drive for a sports team and also counting those hours as your 20 hours for NHS, is not allowed
3. Doing community service for a merit badge in scouting cannot be doubly counted for NHS as well.
• Make sure your hours are something for community service. This means it is something for the community. It should not be something you are expected to do. Rather it should be something you went out of your way to do, without getting monetary compensation, school credit, etc.
• If you are unsure if something will count as hours for NHS, ask Mr.
6WDF\ . Your hours will be looked at carefully by the Faculty
Council.
• Some great examples, from past students are:
- Volunteering in a nursing home.
- Volunteering at the hospital.
- Tutoring at a local elementary school during a free period or after school.
- Coaching in a local youth sports league
• Keep in mind that this is the National Honor Society and our four pillars are Scholarship, Leadership, Service and Character.
Name of NHS Applicant
For community service verification you should type a summary of where you completed these hours and explain what you did. You also need to log the hours and have the supervisor of this activity or a parent/guardian verify your summary with a signature.
How many hours of community service did you complete?
Please give the approximate dates and times of your service:
Briefly summarize your community service activities:
Have an adult other than your parent/guardian who supervised your volunteer hours verify your hours with a signa-
ture and a phone number/e-mail address.
Signature: Phone number: E-mail: