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Blair Magnet National Honor Society Qualification Survey |
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Please complete this qualification survey form as accurately as possible. The completion of this form does not guarantee selection into National Honor Society. This activity information form will be evaluated by the Faculty Council.
For more information about NHS, you can visit http://nhscms.principals.org
Returned this complete form to Ms. Voong by September 28, 2007.
Note: Late
information activity sheets will not be considered.
Please provide the following information:
Name__________________________________________
Grade Level _____________________
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Period |
Class |
Room Number |
Teacher |
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You must be willing to do at the least twenty service hours (12th graders, you must do 40 service hours) in the school community.
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.
I. Administrative Information
Name_________________________________________ Grade___________
Address _____________________________________
_____________________________________
_____________________________________
Phone Number _________________________________
Grade Point Average (GPA) __________ ( It must be a least 3.3)
Counselor’s Name and Verification Signature __________________________________
Names of three teachers who know you well:___________________________________
_______________________________________________________________________
To answer sections II – IV, use the grids that follow each section. For section VI, please use your won paper.
II. Cocurricular Activities – List all activities in which you have participated during high school. Include clubs, teams, musical groups, etc. and major accomplishment in each.
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Activity |
Grade |
# of hours per
week |
Major Accomplishments |
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III. Leadership positions – List all elected or
appointed leadership positions held in school, community or work
activities. For example: elected
student body officer, club officer, committee chairperson, team captain, etc.
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Leadership
Positions |
Grade |
Activity or Organization |
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IV. Community
Activities – List community activities in which you have participated and
not any major accomplishments in each.
These should be any activities outside of school including Health
Careers Academy service hours in which you participated for the betterment of
your community. For example: church groups, scouting groups, volunteer
groups.
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Activity |
Grade |
Accomplishments |
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V. Work Experience, Recognition Awards –
List below any job experiences, honors, or recognitions that you have received
which support your bid to be selected for membership in the National Honor
Society. Work experience may be paid or
volunteer.
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Job/Recognition/Award |
Grade |
Group or Activity # of hours/week |
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VI.
Essay - On a separate sheet of paper answer the
following questions: What other
information does the faculty council need to know about you to help them in the
selection process? Don’t by shy!
If
accepted, you must agree to participate in all Chapter Service Projects,
fundraisers, community service, meetings, and all other events sponsored by the
Blair National Honor Society.
Furthermore, you agree to pay the induction dues of $5.00 and an additional
fee of $45.00 (first year). This will
pay for the graduation apparel. The
annual dues each year thereafter will be $5.00. Failure
to meet or maintain all N.H.S. requirements may result in removal from the
society according to the guidelines established in the by-laws and
constitution.
________________________________
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Student
Signature
Date
________________________________ __________________
Parent
Signature
Date