Chapter of the National Junior Honor Society

A&M Consolidated Middle School

Chapter of the National Junior Honor Society

Student Activity Information Form

(Note: Although this is not an application form, any student wishing to be considered for membership must complete and turn in this form by the required deadline.)

Directions: Please complete all sections. (Please type or print clearly.) 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. A lack of activity in one or more sections does not deny possible admission to membership. Be sure to turn in your completed form, complete with required signatures, in the location designated by the date and time provided as the deadline.

Deadline:

Friday, March 31, 2017, 4:20 pm

(Incomplete or Late Forms will not be accepted.)

Please return complete forms to either Ms. Booker in room 308 or Ms. Rimlinger in room 412.

I. Administrative Information

Name______

(as you might want it to appear on an NJHS membership card or certificate)

Home phone______PRIDE teacher ______

Parent e-mail ______Student e-mail ______

Cumulative grade average______( Must be 93.0 or higher)

( The cumulative grade average will include all seven subjects and be taken from the first through fourth six weeks.)

* To figure the average, add together the 28 grades for the first four six weeks and divide by 28. Do not include semester tests or semester averages. The following high school courses qualify for an additional 10 points to be added to each six weeks average: Algebra I PreAP, Geometry, Algebra II, PreCalculus)

(Attach a copy of your fourth six weeks report card.)

II. Co-curricular Activities - List all activities in which you have participated since the beginning of your seventh grade year. Include clubs, teams, musical groups, etc. and major accomplishments in each.

ActivityAccomplishments

______

______

______

If more room is needed, please attach another sheet.

III. Leadership Positions - List all elected or appointed leadership positions held in school, community, or work activities. Include only those positions in which you were directly responsible for directing or motivating others. For example: elected student body, class, or club officer; committee chairperson; team captain; newspaper editor; work area manager; or community leader.

ActivityAccomplishments

______

______

______

______

______

If more room is needed, please attach another sheet of paper.

IV. Service Activities - List service activities in which you have participated. These can be service projects done with a group or done as an individual (either in or out of school). 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(s) of an adult supervisor who can verify your participation in each activity.

Activity Signature of adult supervisor

______

______

______

______

______

If more room is needed, please attach another sheet of paper.

V. 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 endeavours. Do not repeat participation already listed in other sections of this activity form.

CommunityYear Hrs/Week Major Signature of

Activityaccomplishmentsadult sponsor

______

______

______

______

______

______

If more room is needed, please attach another sheet of paper.

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 Junior Honor Society. Work experience may be paid or volunteer.

Job recognition or award Year Group or activity/Number

of hours spent on job

or volunteer activity

______

______

______

______

______

If more room is needed, please attach another sheet of paper.

I understand that completing this form does not guarantee selection to NJHS, and

that the information presented here is complete and 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 SignatureDate

OR

I have discussed NJHS membership with my daughter/sonand we have agreed to decline taking the necessary steps to seek membership. I realize that my decision in no way affects my daughter’s/son’s eligibility for NHS at the high school level.

______

Parent SignatureDate