Directions: Please complete all sections on the form. Type or print very neatly. Consider this a formal resume of what you have done (similar to a college application so neatness counts!) Every bit of information can be used by the faculty council to Assist with selection.

This is not an application for membership in NHS. Completion if this for does not guarantee selection. Candidates who do not complete this form will not be considered for selection. Please contact Mrs. Wright if you have questions or would like an electronic copy of the form (nwright1@honeoye.org). A copy of the form is available at http://www.mrswright.net.

Administrative information:

Name __________________________________ Grade___________ HR________

Phone # I can notify you by ______________________

Community & Service Activities:

Please list activities and get sponsor signature here; You will fill out additional info in section IV and V of this packet.

Activity/ service

Sponsor Name

Signature of adult sponsor

Student:

I verify that the information presented here is accurate. I understand that completing this form does not guarantee selection to the NHS.

___________________________________________ ______________

Signature date

Parent:

I have read the information presented by my son/daughter on this form and can verify that it is true, accurate and complete in its presentation.

________________________________________ _____________

Signature date

II. CoCurricular activities:

List all activities in which you have participated in high school. Include clubs, teams, musical groups, drama, intramurals etc.

Activity	Year				Accomplishments
	9	10	11	12

III. 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 and motivating others should be included. For example; elected student council, class or club officer; Committee chairperson; Team captain; newspaper editor; work area manager; trainer at work; patrol leader or community leader.

Activity	Year				Accomplishments
	9	10	11	12

IV. Service activities

List service activities in which you have participated. These are activities which you have done on behalf of others( not including family members) for which no compenstion (monetary or other) has been given. Please These can be service projects done with a group, wither in or out of school or individual projects performing service. Please be sure that you listed the name of the an adult supervisor who can verify your participation in each activity on the front of this packet. This person should sign on the front of the form.

Activity	year				Hours/week	Major accomplishments
	9	10	11	12

V. Other community activities:

List other community activities in which you have participated and list accomplishments in each. These should be activities outside of school. Do not repeat any activities listed above. For example Boy or Girl Scouts, Church groups, clubs outside of school, sports teams outside of school or community arts endeavors. Please be sure that you listed the name of the an adult supervisor who can verify your participation in each activity on the front of this packet. This person should sign on the front of the form.

Activity	Year				Accomplishments
	9	10	11	12

VI. Work Experience, recognition and awards: List below any job experience, 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.

Job, recognition or award	year				Group/activity	# of hours spent if it is a job or volunteer activity
	9	10	11	12

VII. Any other information: Is there any other information you would like the selection committee to know?