ADMINSTRATION INFORMATION
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Name: |
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Middle |
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Grade: |
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Counselor |
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HR# |
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HR Teacher |
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MIDDLETOWN HIGH SCHOOL NORTH
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NATIONAL HONOR SOCIETY
To the best of my knowledge and belief the information given is true, correct, and complete. I understand that if I have misrepresented facts on this form, it is sufficient cause for denial of admission or dismissal
Failure to return this form within five (5) days upon receipt will be regarded as your non-acceptance for consideration by the Faculty Council.
Please read the following
statement carefully and sign:
I understand that the completion
of this form in no way guarantees my membership in The National Honor Society, but that I am being consider and
reviewed for membership in accordance with the rules and regulations of The National Honor Society and the local
chapter’s bylaws. I will accept the
decision of the Faculty Council charged with the responsibility of selecting
new members as final.
_______ I wish to be considered for membership.
_______ I do not wish to be considered for membership at this time.
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Student Signature |
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Date |
MIDDLETOWN HIGH SCHOOL NORTH
National
Honor Society
Martha
Pennington Chapter
Student
Activity Information Form
Directions: Please complete all sections. 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. Signatures for each activity must be obtained to verify your
participation.
I. School Sponsored Activities: List all activities in which you participated during high school.
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Activity |
Year |
Accomplishments
(if a leadership position please
indicate here and elaborate below) |
Signature
of Coach/Advisor |
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9 |
10 |
11 |
12 |
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II. Leadership Positions: List all elected or appointed leadership positions held in school, community or work activities. Positions in which you were responsible for directing or motivating others should be included. For example: elected student body; class or club officer; committee chairperson; team captain; newspaper editor; work area manager; or community leader.
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Leadership Position |
Year |
Explanation |
Signature
of Coach/Advisor |
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9 |
10 |
11 |
12 |
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III. Community Service/ Volunteerism: List 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, volunteer groups, or community art endeavors.
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Activity |
Year |
Total
No. Hrs. Worked |
Explanation |
Signature
of Supervisor
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9 |
10 |
11 |
12 |
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