STUDENT ACTIVITY INFORMATION FORM

Oakes High School Chapter of the National Honor Society

I. Administrative Information

Name: ______Grade: ______GPA: ____

II. Extracurricular Activities

List all activities in which you have participated during high school. Include clubs, teams, musical groups, etc. and any major accomplishments in each activity. Be sure to include activities outside the school such as dance or gymnastics.

Year

Activity 9 10 11 12 Accomplishments

III.Leadership Positions

List all elected or appointed leadership positions held in school, community or work activities. Only those positions in which you were directly responsible for directing or motivating others should be included. For example, elected student body, class, or club officer, committee chairperson, team captain, work area or shift manager, or community leader.

Year

Activity 9 10 11 12 Accomplishments

IV. School Service Activities

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

Year

Activity 9 10 11 12 Supervisor

V. Community Service Activities

List any community activities in which you have participated and note any major accomplishments in each. These should be activities outside of school in which you participated for the betterment of your community. These may be activities in which you participate or volunteer on a regular basis (ie. Teaching Sunday school, leading Boy or Girl Scouts, etc.) or activities in which you only participate occasionally. Again, these activities are done for or on behalf of others without compensation. ** Please list the name and phone number of an adult supervisor who can verify your participation in each activity.**

Year

Activity 9 10 11 12 Supervisor

VI. Work Experience, Recognition, and Awards

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

Year

Activity 9 10 11 12 Supervisor

VII. Essay (attach to the application)

Write a short essay stating why you believe you should be a member and what you can offer to the Oakes High School National Honor Society keeping in mind that the goal is to promote service, leadership, character, and scholarship. (250 maximum)

VIII. Letter of Recommendation (attach to application)

Select a supervisor, coach, teacher, or any unrelated adult who can speak about your service, leadership, character, and/or academics. This person should know you well and would likely have a personal or business (such as an employer) relationship with you.

I understand that completing this form does not guarantee selection to the NHS. I also maintain that the information presented here is accurate.

______

Student SignatureDate

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

______

Parent/Guardian SignatureDate