Due Monday, November 4th , to Mrs. Church
YWLA
National Honor Society Interest
Fill out forms completely and return them
to Mrs. Church by 3:55pm
Form
Monday, November 4 . Forms must be typed and printed.
th
Return in this order, with a single staple:
1. This form (typed)
2. Leadership Positions (typed)
3. Service Activities (typed)
4. Your essay (typed)
5. Parent Verification (signed)
6. Contract and Agreement (signed)
7. Teacher recommendation information (signed)
8. Copy of your MOST recent report card.
Submitted by other parties on your behalf:
1. Teacher Recommendation Forms (2)
2. Assistant Principal Signature Form
Please complete all sections. Save a copy of this document on your own
google account to work with. Do not be modest. Every bit of information will
be used by the faculty council to assist with the fair consideration of your
candidacy during the selection process. Completion of this form does not
guarantee selection. Should you have questions on this form, please contact
Mrs. Church (Marissa.Church@fwisd.org). (Keep resume to your high school
years only!)
I.
STUDENT INFORMATION
Name :
Email Address:
Phone Number:
Parent Name:
Parent Phone Number:
Grade:
Due Monday, November 4th , to Mrs. Church
II.
LEADERSHIP POSITIONS
List all elected or appointed leadership positions you held in school, community or
work activities. Only those positions in which you were responsible for directing or
motivating others should be included. For example: elected officer for student
body, class or club; committee chairperson; team captain; newspaper editor; work
area manager; or other community leader. Please include the name of the adult
responsible for supervising your leadership in each position. No adult signature is
needed in this section.
An example is given. Please follow the provided format.
Grade
Leadership Position
Activity /
Organization
Name of
Supervising
Adult
Swim Team
Coach Johnson
Co-Leader
Spanish Club
Mr. Pueblo
Vice President
Student Senate
Mrs. McGovern
9TH (ex.) Co-Captain
9th
10th
11th
12th
Due Monday, November 4th , to Mrs. Church
III.
SERVICE ACTIVITIES
List service activities in which you have participated. These can be individual or
group service projects done either in or out of school. Generally speaking, service
activities are those that are done for or on behalf of others (not including
immediate family members or neighbors) for which no compensation (monetary or
other) has been given. Please ask an adult supervisor who can verify your
participation in each activity (not an immediate family member) to sign on the
appropriate line and also list the number of hours you invested while performing
this service. Yes, adult signature needed!
See the attached sample as to how to type your responses. Please use the given
format.
Grade
Activity
9TH (ex.) Tutored for Curious Kids
Habitat for Humanity
9TH
10th
11th
12th
Hours of Name of Supervising
Service Adult AND SIGNATURE
8
20
Mrs. Kinderwatch
Mrs. Kinderwatch
Mr. Hausen
Mr. Hausen
Due Monday, November 4th , to Mrs. Church
IV.
ESSAY
Please type below a ONE-PAGE, DOUBLE-SPACED, TYPED essay.
In this essay, please answer the following:”Why do you want to be a
member of the National Honor Society?”
Due Monday, November 4th , to Mrs. Church
V.
PARENT VERIFICATION
I understand that completing this form does not guarantee selection to the
National Honor Society. I attest that the information presented here is
complete and accurate. If selected, I agree to abide by the standards and
guidelines of the chapter (see attached contract in following pages) and to
fulfill all of my membership obligations to the best of my ability.
I also understand that the National Honor Society is dedicated to selecting
students based on the categories of Scholarship, Citizenship, Leadership,
and Service. A student must be determined to be exemplary in all categories
by the entire Faculty Selection Committee as reflected in their interest form
and in-school performance. National Honor Society is not an “honor roll.”
Each student will be evaluated based on the same standards of merit and
information sources.
Furthermore, I understand that recommendations and comments made in
confidence by members of the faculty and staff will be kept confidential, and
will only be considered valid for determining student acceptance when
submitted through the proper channels of evaluation. I understand that all
membership decisions are submitted to and approved by the Principal, Mrs.
Hall, prior to student notification.
Student
Signature______________________________________________
I have read the information provided by my student on this form and can
verify that it is true, accurate and complete.
Parent
Signature_____________________________Date______________
Due Monday, November 4th , to Mrs. Church
VI. YWLA NATIONAL HONOR SOCIETY CONTRACT &
AGREEMENT
By signing the statement below, I agree to abide by the terms written here in order
to remain in "good standing" in Young Women's Leadership Academy chapter of the
National Honor Society.
● I will follow YWLA's Code of Conduct, as outlined in the student handbook. If
I am in violation of the handbook and/or if I receive either a In House
Suspension or an Out of School Suspension as a result of that violation, I
realize that I may be subject to removal from the National Honor Society,
based on the discretion of YWLA Faculty Council. If dismissed from NHS, I
realize that I will not be able to wear the traditional NHS regalia at YWLA
graduation during my senior year, nor will I be able to make any claims to
NHS membership on future applications.
● I also agree to complete at least twenty-five (25) hours of community service
activities. Five (5) of these hours may have been completed during the
summer prior to the academic school year. Twenty (20) hours must be
completed during the academic school year. These twenty-five (25) hours
must be spread out over at least three different types of community service
or volunteer activities. I may not count more than ten (10) hours for one
activity without permission of the NHS advisors. I also agree to log and
record all service hours in detail with dates, times, descriptions of events and
phone numbers & names of contact persons on the provided form. This form
is to be turned in within two (2) weeks of event date in order for the hours to
count toward the minimum. If this form is not turned in within two (2)
weeks after participation in the event, I realize that I will not be able to count
these hours towards my total minimum. Donations for Service Learning DO
NOT COUNT.
● If I fail to complete twenty-five hours of community service, by the deadline
posted on the NHS website, I will not be able to wear the traditional regalia
at YWLA graduation. I may also be dismissed from National Honor Society.
● If I fail to maintain the weighted GPA requirement of 4.0 or higher, I will be
placed on probation for a semester. If my GPA does not return to the
minimum 4.0 or higher after one semester of probation, I may be removed
from NHS. (According to the Princeton Review a 4.0 is an average of 96+).
● If I earn more than 2 demerits per six weeks I understand that I may be
placed on probation and I realize that continuous demerits may make me
subject to removal from the YWLA chapter of NJHS/NHS
● Repeated absences from meetings or failure to report to committed
community services events or failure to complete required service hours
could result in dismissal from NHS, as decided by YWLA National Honor
Society Faculty Council.
I agree to the terms above.
Printed Name____________________________________________
Student Signature_________________________________________
Due Monday, November 4th , to Mrs. Church
Parent Signature__________________________________________
VII.
TEACHER RECOMMENDATION FORMS
Write your name on both of the attached recommendation forms. Ask a
staff member who knows you well to fill out the form on your behalf. Give a
form to two different staff members. Ask the teacher to please sign their
name on your signature page. The staff member will complete the separate
form and he/she will return it to the counseling office. You SHOULD NOT see
the form after you give it to the person recommending you.
Student Name:________________________________________________
I agree to complete and submit a teacher recommendation form for
the above student and submit it directly to the guidance office.
Teacher Name 1 (print)
_______________________________________________
Teacher Signature 1
_______________________________________________
Teacher Name 2 (print)
_______________________________________________
Teacher Signature 2
_______________________________________________
Due Monday, November 4th , to Mrs. Church
VI.
Dean of Student’s or Dean of Instruction’s SIGNATURE
Fill out your name and grade level.
Name:_______________________________ Grade____________
Take this form to your grade-level principal. The principal will complete this
form and submit it directly to Mrs. Church.
Has this student ever been in violation of the YWLA Student Code of
Conduct?
Yes
________
No
________
If “yes”, please explain below, in detail.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
____
Do you recommend this student for NHS membership?
Yes
____ No ____ Student not known well enough to comment ______
What are the first words that come to your mind in regards to this student
(if you know him/her well)?
Dean’s Signature
Signature______________________________________Date___________
Due Monday, November 4th , to Mrs. Church
NATIONAL HONOR SOCIETY
Teacher Recommendation #1
Student:
Bring this form to a teacher or faculty member of your choice here at YWLA.
Fill out your name and the recommending teacher’s name. Ask the teacher
to complete the form by Monday, November 4th and to return it to Mrs.
Church.
Teacher:
Your recommendation will be used to help the advisory committee select
candidates for The National Honor Society. This form is intended to assess
the student’s character. This information is confidential! This form should
be returned to the Mrs. Church by Monday, November 4th. Do not return to
student as the student should not see the completed form.
Please respond to this recommendation as honestly as possible.
STUDENT NAME (print):
____________________________________________
TEACHER RECOMMENDING (print):
____________________________________________
PLEASE ADHERE TO THIS RUBRIC AND USE IT CAREFULLY. THANK YOU.
1
2
3
4
5
N.O.
Low
Average
Good
Great
(top 5% this
year)
Superb (top
5% of all
time)
Not
Observed
ATTENDANCE
“I WILL HELP ATTITUDE”
INTEGRITY
HONESTY
SELFLESSNESS
RESPONSIBILITY
CHARACTER
LEADERSHIP
CONCERN FOR OTHERS
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
N.O.
N.O.
N.O.
N.O.
N.O.
N.O.
N.O.
N.O.
N.O.
Feel free to add any and all comments that support the candidate on the
back of this form. Please be specific. Thank you.
Teacher Signature
________________________________________________
Due Monday, November 4th , to Mrs. Church
NATIONAL HONOR SOCIETY
Teacher Recommendation #2
Student:
Bring this form to a teacher or faculty member of your choice here at YWLA.
Fill out your name and the recommending teacher’s name. Ask the teacher
to complete the form by Monday, November 4th and to return it to guidance.
Teacher:
Your recommendation will be used to help the advisory committee select
candidates for The National Honor Society. This form is intended to assess
the student’s character. This information is confidential! This form should
be returned to Mrs. Church by Monday, November 4th. Do not return to
student as the student should not see the completed form.
Please respond to this recommendation as honestly as possible.
STUDENT NAME (print):
____________________________________________
TEACHER RECOMMENDING (print):
____________________________________________
PLEASE ADHERE TO THIS RUBRIC AND USE IT CAREFULLY. THANK YOU.
1
2
3
4
5
N.O.
Low
Average
Good
Great
(top 5% this
year)
Superb (top
5% of all
time)
Not
Observed
ATTENDANCE
“I WILL HELP ATTITUDE”
INTEGRITY
HONESTY
SELFLESSNESS
RESPONSIBILITY
CHARACTER
LEADERSHIP
CONCERN FOR OTHERS
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
N.O.
N.O.
N.O.
N.O.
N.O.
N.O.
N.O.
N.O.
N.O.
Feel free to add any and all comments that support the candidate on the
back of this form. Please be specific. Thank you.
Teacher Signature
________________________________________________