HEDGESVILLE HIGH SCHOOL

EAGLE CHAPTER

NATIONAL-HONOR SOCIETY

DIRECTIONS: Please complete all sections – Only typed applications will be considered. Do not be modest. Every bit of information can be used by the Faculty and Faculty Council to assist with the selection process. Completion of this form does not guarantee selection. If more space is needed, the same format must be used as in sections II-VIII

I. Administrative Information1st period teacher:______

1. ______

Name

2. ______

Address

3. ______4. ______

City State Zip Code

5. ______

Parent(s)/Guardian(s)

6. Click the grade that you are in:JuniorSenior

II. Scholarship - ** Numbers 1 & 2 are to be filled in by Mrs. Stenson/Ms. Kearse **

1. Current Grade Point Average (Cumulative through first semester)______

2. Current Class Rank______of ______students

3. Courses Taken In High School: Please complete the chart, listing courses under each heading. Please be sure to include Honors, AP, and other information as necessary.

Grade 9 / Grade 10 / Grade 11 / Grade 12
1. / 1. / 1. / 1.
2. / 2. / 2. / 2.
3. / 3. / 3. / 3.
4. / 4. / 4. / 4.
5. / 5. / 5. / 5.
6. / 6. / 6. / 6.
7. / 7. / 7. / 7.
8. / 8. / 8. / 8.

III. Curricular Activities:List all activities in which you have participated during high school. Include clubs, teams, musical groups, etc., and major accomplishments in each. Mark the years in which you participated in each with an X.

Activity / 9 / 10 / 11 / 12 / Accomplishments

IV. 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, community chairperson, team captain, newspaper editor, work area manager, or community leader. Mark the years which you participated in each with an X.

Activity / 9 / 10 / 11 / 12 / Accomplishments

V. 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 otherwise) has been given. Please list the name of an adult supervisor who can verify your participation in each activity. Mark the years which you participated with an X.

Activity / 9 / 10 / 11 / 12 / Adult Sponsor

VI. 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: church groups, clubs sponsored outside the school, Boy or Girl Scouts, or community art endeavors. Do not repeat participation already listed above. Mark the years which you participated in with an X.

Community
Activity / 9 / 10 / 11 / 12 / Hours/Week / Major Accomplishments / Adult Sponsors Signature

VII. 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. Mark the years in which you participated in each with an X.

Job, Recognition, or Award / 9 / 10 / 11 / 12 / Group or Activity/
Number or Hours Spent on Job
Or Volunteer Activity

VIII. Signatures

I understand that completing this form does not guarantee selection to NHS, and that the information presented here is accurate. I have read and understand the process by which the selection is completed on a nationwide basis. I agree to let this information enter into this chapter’s selection pool understanding fully that my activity form will be a part of this nationwide process of selection.

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 presentation. I also understand that this application does not guarantee selection to NHS, and I have read and understand the process by which the selection is completed on a nationwide basis.

Parent SignatureDate

Thank you very much for taking the time to fill out this information, and congratulations on being selected as a National Honor Society nominee.