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 YEAR ADULT SUPERVISOR

(With description) (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