Marina High School Chapter of the National Honor Society

The National Honor Society recognizes students for outstanding scholarship, leadership, service, and character.

Student Activity Information Form

DIRECTIONS:

  1. Complete all sections.All of the information will be reviewed by the Faculty Council. Incomplete forms will not be considered. Completion of this form does not guarantee selection.
  2. Submit this information form to Mrs. Miler, Counselor by Monday, October 16, 2017.
  3. Please note that if you are selected as a member of NHS you will be required to submit $10 membership dues.
  1. Student Information

NAME: / CLASS OF: / I.D.#
E-Mail: / Primary Phone Contact: / Date:
  1. Scholarship: Cumulative weighted 9-12 grade point average ______
  2. Leadership: List all leadership roles in the classroom, at work, school, or community where you were directly responsible for directing or motivating others to perform a specific activity or task. Attach additional papers if you need more spaced than provided.

Past Leadership Position / Circle Grade level(s) when position was served 9 10 11
Title
Organization or place of position
Description of responsibilities:
Supervisor Name:
Supervisor E-Mail or Phone Contact:
Past Leadership Position / Circle Grade level(s) when position was served 9 10 11
Title
Organization or place of position
Description of responsibilities:
Supervisor Name:
Supervisor E-Mail or Phone Contact:
Past Leadership Position / Circle Grade level(s) when position was served 9 10 11
Title
Organization or place of position
Description of responsibilities:
Supervisor Name:
Supervisor E-Mail or Phone Contact:
Leadership Positions for 2017-2018 School Year
Title: Organization or place of position:
Title: Organization or place of position:
Title: Organization or place of position:
  1. Service: Volunteer activities at school or in the community done with or on behalf of others (not including immediate family members) without compensation, reward, or educational credit. Attach additional pages if additional space is needed.

Date(s) / Activity description (briefly describe your act(s) of service including location/organization/event title) / Hours / Printed Name andSignature of Adult Sponsor/Advisor

Total Hours ______

I understand that completing this form does not guarantee selection to NHS, and that information presented here is accurate.

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 in its presentation.

Parent/Guardian Signature ______Date ______

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