NorthwestMiddle School

National Junior Honor Society Form

Due: January 30, 2015

Return to: Mrs. McAninch (front office) or English Teacher.

*One section may be left blank and still eligible

Directions: Please complete all sections (Please type or print). Do not be modest. Every bit of information can be used by the Faculty Council to assist with the selection process. Completion of this form does not guarantee selection and you must maintain a 3.5 GPA and excellent conduct to remain in the society. Be sure to turn in your completed forms, complete with required signatures, in the location designated by the date and time provided as the deadline.

I. Administrative Information

Name

Homeroom Teacher

II. Co-curricular Activities – List all activities in which you have participated since the 5th grade. Include clubs, teams, musical groups, etc., and major accomplishments in each.

Activity / Year /
Accomplishments
5 / 6 / 7 / 8

III. Service Activities– List service activities in which you have participated. These can be service projects done with a group either in or out of school, or done as individual projects performing service. Generally speaking, service activities are those which are done for or on behalf of others (not including immediate family members) for which no compensation (monetary or other) has been given. Please list the name of an adult supervisor who can verify your participation in each activity.

Activity / Year / Signature of Adult supervisor (optional)
5 / 6 / 7 / 8

IV. Other Community Activities– List other community activities in which you have participated and note any major accomplishment in each. These should be any activities outside of school in which you participated for the betterment of your community. For example: religious groups, clubs sponsored outside the school, Boy or Girl Scouts, or community art endeavors. Do not repeat participation already listed above.

Community Activity / Year /
Hours per
Week /
Major Accomplishments / Signature of Adult Sponsor (optional)
5 /
6 /
7 /
8

V. Recognition, Awards, Work Experience– List below any job experiences, honors, or recognition that your have received that support your bid to be selected for membership in the National Junior Honor Society. Work experience may be paid or volunteer.

Recognition or Award / Year / Group or Activity/ Number of hours spent on job or volunteer activity
5 / 6 / 7 / 8

I understand that completing this form does not guarantee selection to NJHS, and that the information presented here is complete and accurate. One section may be left blank and all lines do not have to be completed.

Student SignatureDate

I have read the information provided by son/daughter on this form and can verify that it is true, accurate and complete in its presentation.

Parent SignatureDate