Eleanor Roosevelt High School: National Honor Society Application
Full Name
Do Not Write in This Space-NHS Faculty Use
Address
City, State,
Zip
Phone
Date Application Received
Date Application Reviewed
ID & Grade
Level
Date of Notification
Membership Status
Accepted/Declined
The criteria for election to the National Honor Society (NHS) are:
Scholarship
Character
Leadership
Service
Minimum requirements for NHS membership can be found on the school’s website under “Activities” and
“NHS”. Your academics will determine whether you have met the requirements for Scholarship. The standards
of Character, Leadership and Service will now be reviewed in a variety of ways (this packet, the ERHS faculty,
the NHS faculty selection committee).
Complete this application packet.
Use only the space provided.
Please type your essay using Times New Roman, 12 point font, single-spaced, and 450-500 words.
Essays may be attached to the application as an additional page.
Ask four (4) of your teachers to recommend you for NHS by filling out the brief evaluation form.
Make sure you and a parent read, sign and turn in the packet.
Attach current transcripts to this packet.
Have a club advisor, employer, or a teacher for whom you have worked for (tutor, teacher assistant,
volunteer) complete the Character, Leadership, and Service Evaluation Form.
SIGNATURE FORM
I have read this packet and to the best of my knowledge have completed the attached information packet.
I understand that returning this information packet puts my name in consideration for membership but does not
guarantee an invitation to become a member.
Student Signature _______________________________________________________________
Signature of Parent/Guardian __________________________________ Date_______________
ERHS NHS Application, 08/11
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Student Name:__________________________________________ID:____________________________
EXTRACURRICULAR ACTIVITIES
(Please list your 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 AWARDS
(Briefly describe any other scholastic distinctions or leadership honors you have won or earned beginning with ninth
grade, such as science fairs or departmental awards.)
COMMUNITY SERVICE
(Include activities undertaken which were done on behalf of others without any material compensation to the individual
performing the service.)
OTHER ACTIVITIES, HOBBIES, WORK EXPERIENCE
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Student Name_________________________________________ ID______________________________
PERSONAL STATEMENT
The 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. This essay must be typed, single-spaced, Times New Roman, 12-pt. font, and needs to be between 450-500 words. You
may type the essay on a separate sheet and attach it to this packet.
We know you are a successful student. Tell us more about who you are as a person – what makes you different or unique?
How do you exemplify scholarship, service, leadership, and character?
My signature below indicates that all information in my application is complete, factually correct, and honestly presented.
Signature _____________________________________________________________ Date ___________________
ERHS NHS Application, 08/11
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You will need four (4) teacher recommendations. Please make four copies of this page for your teachers.
Teacher Recommendation Form
Student Applicant’s First and Last Name:________________________________________________________
Grade Level:______________
ID:_______________
Teachers: Thank you for filling out this recommendation for the above named student who is applying to Eleanor
Roosevelt’s chapter of National Honor Society. As established by the national charter, 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 the box that is 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.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Additional Comments:
Teacher Name:______________________________Signature:____________________________Date:_______________
Thank you for your time. Please return this evaluation to the student in a sealed envelope or to F132 Office within 5 days.
ERHS NHS Application, 08/11
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This form is to be filled out by a club advisor, employer, or teacher for whom you have worked for (tutor, teacher aid,
volunteer).
Character, Leadership, and Service Evaluation Form
Student’s Full Name ______________________________________________________
School/Grade__________________________________________________
Instructions: Please check one statement in each category that best describes the applicant’s attitude and performance.
Additional comments are welcome! After you have completed this rating please return it within five (5) days to the
applicant in a sealed envelope or to Eleanor Roosevelt High School, 7447 Cleveland Avenue, Eastvale, California 92880,
Attention: National Honor Society Faculty Council, Kim Lu.
LIST STUDENT’S JOBS/ACTIVITIES/CLUBS/AWARDS: ______________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
1. PUNCTUALITY
 ALWAYS ON TIME
 USUALLY ON TIME
 FREQUENTLY LATE: No. of Days:________
6. RELATIONS WITH OTHERS/ADULTS
 IS COURTEOUS AND CONSIDERATE OF OTHERS
 SHOULD BE MORE CONSIDERATE
 HAS BEEN DISCOURTEOUS/RUDE
2. ATTENDANCE
 OUTSTANDING
 SELDOM ABSENT
 FREQUENTLY ABSENT: No. of Days
7. INITIATIVE
 INITIATES TASKS; IS SELF-DIRECTED
 REQUIRES NORMAL DIRECTION
 MUST HAVE CONSIDRABLE DIRECTION
3. PERSONAL APPEARANCE
 ALWAYS APPROPRIATE FOR JOB
 OCCASIONALLY NOT APPROPRIATE
 APPROPRIATE DRESS NEEDS TO BE DISCUSSED
8. JOB PERFORMANCE
 IS ACCURATE; ATTENTIVE TO DETAILS
 USUALLY ACCURATE AND RELIABLE
 OUTPUT IS UNSATISFACTORY
NOTE WHY:_________________________________
4. ATTITUDE TOWARDS LEARNING
 IS ENTHUSIASTIC; COOPERATIVE; EAGER TO DO
A GOOD JOB
 GENERALLY COOPERATIVE
 RELUCTANT TO DO MORE THAN HAS TO
 UNCOOPERATIVE; PUTS OUT LITTLE EFFORT
5. ATTITUDE TOWARD SUPERVISION/WORKING W/PEERS
 PROFITS BY SUGGESTIONS
 HAS DIFFICULTY ACCEPTING SUGGESTIONS
 DOES NOT ACT ON SUGGESTIONS GIVEN
OVERALL RATING
 5 EXCELLENT
 4 GOOD
 3 AVERAGE
 2 IMPROVEMENT NEEDED IN SOME AREAS
 1 UNSATISFACTORY
Would you recommend this student for Eleanor
Roosevelt High School’s National Honor Society?
_____ YES
_____ YES, with hesitation (Please explain below.)
_____ NO
ADDITIONAL COMMENTS IF APPLICABLE:
________________________________________________________________________________
________________________________________________________________________________
Advisor’s Name_____________________________________Title________________________Date__________
Advisor’s Signature__________________________________________Company__________________________
ERHS NHS Application, 08/11
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Eleanor Roosevelt High School’s National Honor Society Application Checklist
Please turn in your completed application packet by the due date. The application packet must include:




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Completed application
450-500 word essay typed, single-spaced, Times New Roman, 12 point font
Most current transcripts
Four (4) completed and signed teacher evaluations
Character, Leadership, Service Evaluation Form to be completed and signed by a club advisor, employer, or
teacher who can evaluate your character, leadership, and service outside of the classroom.
NOTE: A $25.00 membership fee will be due once a student has been accepted.
National Honor Society applications are accepted once a year, usually within the first 60 days from the start
of school. Completed applications will be turned in to Eleanor Roosevelt High School’s National Honor
Society Faculty Council in Building F132. Application deadlines will be posted on the school’s NHS
webpage. If you have further questions, please contact Mrs. Kim Lu, Assistant Principal, in Building F132,
or Mr. Vincent Flores, NHS Faculty Advisor..
ERHS NHS Application, 08/11
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