VISTA MURRIETA HIGH SCHOOL

CHAPTER OF THE NATIONAL HONOR SOCIETY

Student Survey2016-2017

Directions: Please complete all sectionsof this survey using your high school experience only. TYPE all information and submit it by the published deadline. Do not be modest. All information will be used by the NHS faculty council to evaluate your candidacy during the selection process. Completion of this form does not guarantee selection. Should you have questions about this form, please contact the NHS Faculty Advisor by email: Ms. Lê – DEADLINE: FRIDAY, OCTOBER 14, 2016 BY 3:00 P.M.

  1. ADMINISTRATIVE/DEMOGRAPHIC INFORMATION (PLEASE PRINT CLEARLY)

Name:______Student ID Number:______Date Submitted:______

LastFirstMiddle

Mailing Address: ______CA ______D.O.B ___/____/______

Street No. /P.O. BoxCity Zip Code

Home phone: (_____)______Cell phone: (_____) ______Texting? ____ Parent day phone: (____) ______

Parent Email: ______Student Email: ______

Parent Names: (Please Print) ______

Cumulative Academic GPA (MUST have a minimum (weighted) 4.0):______Grade Level (MUST be grades 10 or 11): ______

II.SIGNATURES (sign in blue or black ink!)

I understand that completing this form does not guarantee selection to the 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 and to fulfill all of my membership obligations to the best of my ability.

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: ______

III . STUDENT RECOMMENDATIONS (accounts for 20% of overall rating)

PRINT OUT 3 RECOMMENDATION FORMS FROM THE NHS LINK ON MS. LÊ’S WEBSITE.

Submit 3 student RECOMMENDATIONSto your teachers, staff members, or club advisors. Be certain to choose someone who can evaluate your character and leadership ability. Recommendations ARE NOTto be returned tothe student candidate but rather should be directed to the NHS Faculty Advisor, Ms. Lê (Room EE15) in a confidential manner.Surveys WITHOUT the correct number of recommendations WILL NOT BE CONSIDERED.

IV.LEADERSHIP POSITIONS (ACCOUNTS FOR 30% OF OVERALL RATING)

List all leadership positions held in school and in your community. Leadership positions may be elected, appointed, or volunteered. Only those positions in which you were responsible for directing or motivating others should be included. Include the name and contact number of the adult responsible for supervising your leadership in each position. Circle a grade level at the time of the leadership activity.

Grade Level Leadership Position Activity or Organization Supervising Adult Name/Contact #

9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
  1. SERVICE ACTIVITIES (ACCOUNTS FOR 30% OF OVERALL RATING)

Service activities are those that are done on behalf of others (excluding immediate family members) for which no compensation (monetary or other)has been given. Activities can be individual or group service projects done either in or out of school. You must indicate the number ofhours(round up to nearest 10) and collect signatures of adult supervisors who can verify your participation in each activity. Circle your grade level at the time of the service activity.

GradeLevel Activity Hours of Service Supervising Adult Name/Contact#

9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
  1. EXTRACURRICULAR ACTIVITIES (ACCOUNTS FOR 20% OVERALL RATING)

List all other school-based and community activities that have not yet been listed. Include clubs, team sports, musical groups, organizations, Scouts, religious activities, community art endeavors, etc.Do not repeat activities/positions already listed in service or leadership categories. Circle your grade level at the time of the extracurricular activity.

Grade LevelActivity Accomplishments

9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12
9 10 11 12

RETURN COMPLETED FORM AND THREE RECOMMENDATION FORMS (STAFF WILL SUBMIT TO MS. LÊ) TO THE NHS ADVISOR (MS. LÊ – EE15)

DEADLINE: FRIDAY, OCTOBER 14, 2016, BY 3:00 P.M. IN ROOM EE15– NO EXCEPTIONS!

  1. STUDENT ESSAY

Each Candidate is required to provide a personal essay of 750 words (minimum)to the NHS Faculty Council that explains why the candidate believes he or she should be considered for the National Honor Society and what contribution he or she would contribute to an organization that lives out the four qualities of Scholarship, Service, Character and Leadership on the VMHS campus.

The essay should be typed in the MLA format with a formal student header and a signature and date at the end of the piece.ALWAYS SIGN IN BLUE OR BLACK INK.

Sample Student Header:

Smart Student Student 1
Ms. Lê
National Honor Society
14 October 2016
National Honor Society Consideration Essay (Word Count = 750 words)

The essay should be submitted with the survey form by the DEADLINE: FRIDAY, OCTOBER 14, 2016, BY 3:00 P.M. IN ROOM EE15– NO EXCEPTIONS!