national honor society application for membership william … · 2015. 7. 23. · 2...
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Name (print)__________________________________________________
National Honor Society
Application for Membership
William Tennent High School
2015-2016
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Congratulations, you have been nominated to apply for William Tennent’s High School’s chapter
of the National Honor Society. Only students with a cumulative non-weighted GPA of 3.5 or above
may apply. If you are interested in becoming a member, please fill out the attached application.
The following checklist may be of assistance to you to ensure a complete application.
_____________1.) Student Information
_____________2.) Student and Guardian Signatures
_____________3.) Leadership Document with Signatures
_____________4.) Service Activities with Advisor Validation
_____________5.) Two Completed Evaluations with Advisor Validation
_____________6.) Completed Essay
Selection Process:
Selection to NHS is a privilege and an honor, not a right. Students do not apply for
membership in the National Honor society; instead, they provide information to be
used by the selection committee to support their candidacy for membership.
Membership is granted only to those students selected by the Faculty Council.
Membership is not automatically conveyed simply because a student has achieved a
specified level of academic performance. William Tennent’s local chapter of the
NHS emphasizes the components of leadership, service, and character in the
selection process.
By completing this application, you have acknowledged that you accept the process
of selection by the Faculty Council and understand that selection is final.
Deadline: This application must be completed and returned to Mrs. Albrecht in A-109 by
Thursday, October 1, 2015 by 3:00 p.m. Applications not received or fully
completed by this date will not be considered. Acceptance and denial letters will
be given out on October 19th. If accepted, our NHS Induction ceremony will be
on October 29th at 7:00 pm.
Signature: Upon completion, please finalize this application by signing below.
Applicant: ____________________________________________________Date_______________
Parent/Guardian: _______________________________________________Date_______________
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STUDENT INFORMATION:
Name___________________________________________________________________________ Last First Middle
Grade (2015-2016) ____________ 1st Period Classroom Teacher:__________________
Address_________________________________________________________________________ Street City State Zip code
Phone Number_______________________________________
E-Mail Address (Please Write Very Clearly)__________________________________________
To be completed by your grade level disciplinarian
List any discipline referrals this student has received since freshman year. Please be sure to include
a brief description of the issue(s).
(PLEASE HAND THIS FORM TO THE YOUR HOUSE SECRETARY FOR
YOUR GRADE LEVEL DISCIPLINARIAN TO COMPLETE)
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Leadership:
The leadership criterion is considered highly important for membership selection. Some
Faculty Councils may wish to interpret leadership in terms of the number of offices held in school
or community organizations. It is important to recognize that leadership also exists outside elected
positions including effective participation in other co curricular activities offered on campus. Other
Faculty Councils may define leadership in less objective terms. Leadership roles in both the school
and community may be considered, provided they can be verified.
The student who exercises leadership:
Is resourceful in proposing new problems, applying principles, and making suggestions
Demonstrates initiative in promoting school activities
Exercises positive influence on peers in upholding school ideals
Contributes ideas that improve the civic life of the school
Is able to delegate responsibilities
Exemplifies positive attitudes
Inspires positive behavior in others
Demonstrates academic initiative
Successfully holds school offices or positions of responsibility; conducts business
effectively and efficiently; demonstrates reliability and dependability
Is a leader is the classroom, at work, and in other school or community activities
Is thoroughly dependable in any responsibility accepted
Is willing to uphold scholarship and maintain a loyal school attitude.
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Name (print)__________________________________________________
Leadership Positions: List all elected or appointed leadership positions held in school, community,
or work activities. Please include only those positions in which you were directly responsible for
motivating others. For example, elected student class, or club officer, team captain, newspaper
editor; or work area manager; are all positions that satisfy this criteria. Please feel free to include a
letter of recommendation from someone outside the school who may be familiar with your
leadership positions.
Activity
Leadership
Position
Grade
9
Grade
10
Grade
11
Grade
12
Sponsor Signature
EXPAND: Feel free to expand on any or all of the leadership positions listed above.
A form is provided to have the leadership sponsor fill out. Make copies as needed, provide the
sponsor with an envelope. These forms should be in a sealed envelope, with their signature on the
seal, and handed back to you September 28 in order for you hand them in to complete your
application.
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WILLIAM TENNENT NATIONAL HONOR SOCIETY
LEADERSHIP EVALUATION FORM
TO BE COMPLETED BY APPLICANT:
Name of student: ________________________________________
Leadership Activity: _________________________________________________
Length of Time in Activity (only count since the end of 9th grade): ____________________
FOR THE ADULT SUPERVISOR:
We are considering a member of your activity for induction into the National Honor Society. For the
purpose of examining their leadership role, the student should have requested from you a letter confirming
their position. Ideally, this letter should be on company letterhead, and include the leadership position.
Please specify years and dates.
Please do not include the applicants name within the letter itself. Please put
his/her name outside the sealed envelope and/or on the back side of the letter.
For clarification, leadership is considered when a student is responsible for directing and/or teaching
others. Examples include, but are not limited to: tutor in academic subjects, camp counselor, captain of a
sports team, athletic coach, work manager or trainer, religious instruction teacher, orchestra section
leader, or a newspaper editor.
Please attach the letter to this form and place in a sealed envelope (provided to you by the student), sign
over the seal, and return to the student BEFORE OR ON September 28. Thank you for your time.
Mrs. Albrecht
NHS Advisor
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Service:
Service is generally considered to be those actions taken by the student which are done with
or on behalf of others without any direct financial or material compensation to the individual
performing the service. In considering service, the contributions this candidate has made to school,
classmates, and community, as well as the student’s attitude toward service can be reviewed.
The student who serves:
Volunteers and provides dependable and well organized assistance, is gladly
available, and is willing to sacrifice to offer assistance
Works well with others and is willing to take on difficult or inconspicuous
responsibilities
Cheerfully and enthusiastically renders any requested service to the school
Is willing to represent the class or school in inter-class and inter-scholastic
competition
Does committee and staff work without complaint
Participates in some activity outside of school- for example: Girl Scouts, Boy
Scouts, church groups, volunteer services for the elderly, poor, or disadvantaged
Mentors persons in the community or students at other schools
Shows courtesy by assisting visitors, teachers, and students.
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SERVICE ACTIVITIES
Please list all the service activities in which you have participated through the course of the
past and current school year.
Guidelines:
1. Students must complete 4 hours of community service from July 1, 2015 to when the
application is submitted.
2. At minimum, the evidence of leadership service should be equivalent to ½ hour weekly for
a minimum of one marking period.
3. Leadership events may overlap with Community service events.
Examples:
1.) In School or School Related
Clubs/Organizations in school that involve service
2.) Out of School
Clubs/Organizations such as Boy/Girl Scouts, Church Groups, Serving the Elderly,
Children or the Disabled, etc.
3.) Interscholastic competition/Sports
School Sports Teams, Debate, Mock Trials, Marching Band, Chorale, etc.
________________________________________________________________________________
SERVICE ACTIVITY SPONSOR SIGNATURE
***PLEASE NOTE: This form will be accepted only with advisor validation***
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Character:
National Honor Society is a member of the Character Counts! Coalition. Through this
activity, the society supports and recommends the use of a multi-faceted definition of character
known as the “Six Pillars of Character.” A person of character demonstrates the following six
qualities: respect, responsibility, trustworthiness, fairness, caring, and citizenship. Schools are
encouraged to take this model, modify it to meet their local needs, and utilize it frequently in the
work of their chapter.
In addition, it can also be said that the student of character:
Takes criticism willingly and accepts recommendations graciously
Consistently exemplifies desirable qualities of behavior (cheerfulness,
friendliness, poise, stability)
Upholds principles of morality and ethics
Cooperates by complying with school regulations concerning property,
programs, office, halls, etc.
Demonstrates the highest standards of honesty and reliability
Regularly shows courtesy, concern, and respect for others
Observes instructions and rules, is punctual, and faithful both inside and outside
the classroom
Has powers of concentration, self-discipline, and sustained attention as shown by
perseverance and application to studies
Manifests truthfulness in acknowledging obedience to rules, avoiding cheating in
written work, and showing unwillingness to profit by the mistakes of others
Actively helps rid the school of bad influences or environment.
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National Honor Society – Evaluation of Character It is your responsibility to ensure that each character evaluation is handed in to Mrs. Albrecht on time. Please
feel free to stop by her room to check.
____________________________________ (name) is in the process of applying for induction to
the National Honor Society. Please complete this survey to give NHS a reflection of
CHARACTER for the applicant. Thank you for your cooperation.
Would you describe this person as:
Very Strong Strong Average Below Average Minimal
A good listener 5 4 3 2 1
Reflective 5 4 3 2 1
Dependable 5 4 3 2 1
Even-tempered 5 4 3 2 1
Confident 5 4 3 2 1
Supportive 5 4 3 2 1
Understanding 5 4 3 2 1
Open-minded 5 4 3 2 1
Independent thinker 5 4 3 2 1
Energetic 5 4 3 2 1
Fair-minded 5 4 3 2 1
Caring/Kind 5 4 3 2 1
Compassionate 5 4 3 2 1
Appreciative 5 4 3 2 1
Courteous 5 4 3 2 1
Adaptable/Flexible 5 4 3 2 1
Encouraging 5 4 3 2 1
Respectful 5 4 3 2 1
Patient 5 4 3 2 1
(over)
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Very Strong Strong Average Below Average Minimal
Considerate 5 4 3 2 1
Goal-oriented 5 4 3 2 1
Trustworthy 5 4 3 2 1
Additional Comments:
The person completing this character evaluation can be inside or outside of school (church
members, social group coordinators, employers, etc.) NO FAMILY MEMBERS!
Please return this survey to Michelle Albrecht via interschool mail or 333 Centennial Road,
Warminster, PA 18974 postmarked no later than Tuesday, September 29, 2015. Any surveys
received after Thursday, October 1, 2015 and not postmarked by September 29, 2015 will not be
accepted.
Name (print)_______________________________________Title___________________________
Signature______________________________________________ Date______________________
Relationship to student_____________________________________________________________
Number of years you have known this student___________________________________________
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National Honor Society – Evaluation of Character It is your responsibility to ensure that each character evaluation is handed in to Mrs. Albrecht on time. Please
feel free to sto by her room to check.
____________________________________ (name) is in the process of applying for induction to
the National Honor Society. Please complete this survey to give NHS a reflection of
CHARACTER for the applicant. Thank you for your cooperation.
Would you describe this person as:
Very Strong Strong Average Below Average Minimal
A good listener 5 4 3 2 1
Reflective 5 4 3 2 1
Dependable 5 4 3 2 1
Even-tempered 5 4 3 2 1
Confident 5 4 3 2 1
Supportive 5 4 3 2 1
Understanding 5 4 3 2 1
Open-minded 5 4 3 2 1
Independent thinker 5 4 3 2 1
Energetic 5 4 3 2 1
Fair-minded 5 4 3 2 1
Caring/Kind 5 4 3 2 1
Compassionate 5 4 3 2 1
Appreciative 5 4 3 2 1
Courteous 5 4 3 2 1
Adaptable/Flexible 5 4 3 2 1
Encouraging 5 4 3 2 1
Respectful 5 4 3 2 1
Patient 5 4 3 2 1
(over)
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Very Strong Strong Average Below Average Minimal
Considerate 5 4 3 2 1
Goal-oriented 5 4 3 2 1
Trustworthy 5 4 3 2 1
Additional Comments:
The person completing this character evaluation can be inside or outside of school (church
members, social group coordinators, employers, etc.) NO FAMILY MEMBERS!
Please return this survey to Michelle Albrecht via interschool mail or 333 Centennial Road,
Warminster, PA 18974 postmarked no later than Tuesday, September 29, 2015. Any surveys
received after Thursday, October 1, 2015 and not postmarked by September 29, 2015 will not be
accepted.
Name (print)_______________________________________Title___________________________
Signature______________________________________________ Date______________________
Relationship to student_____________________________________________________________
Number of years you have known this student___________________________________________
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ESSAY
Discuss the essay topic. The essay should be between two hundred and two
hundred and fifty words and must be typed. If it is not typed, it will not be
accepted. Please be attentive to spelling and grammar.
Leadership:
Discuss what leadership means to you
Explain, in your words, an important attribute of a strong leader
Discuss how your leadership roles that you have listed in this application will
benefit the Centennial School District community