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M O N T G O M E R Y C O U N T Y P U B L I C S C H O O L S
NATIONAL HONOR SOCIETY MONTGOMERY BLAIR HIGH SCHOOL CHAPTER
APPLICATION FORM
Name: Junior/Senior:
Address:
Email Address (PRINT):
GPA (cumulative 3.3): SSL Hours: Deadline/Due: September 29, 2017
1. Service Hour Requirement (at least 120 SSL hours) List major service projects.
Organization Year Accomplishments
9 10 11 12
sd
2. Co-curricular Activities List activities, clubs, and teams you have participated in high school.
Activity Year Accomplishments
9 10 11 12
3. Two (2) Letter of Recommendations (Academic, Leadership) Forms attached.
1. _________________________________________ Position: ____________________________
2. _________________________________________ Position: ____________________________
4. Leadership Positions
Organization Year Accomplishments
9 10 11 12
The information I have provided is, to the best of my knowledge, accurate and complete. I have
read the selection procedures and agree to fulfill the responsibilities of membership in the
Montgomery Blair Chapter of the National Honor Society.
______________________________ ______________________________
Candidate's Signature Parent's Signature
M O N T G O M E R Y C O U N T Y P U B L I C S C H O O L S
NATIONAL HONOR SOCIETY MONTGOMERY BLAIR HIGH SCHOOL CHAPTER
CHECKLIST
_______ I have verified that I have a minimum of a 3.3 cumulative grade point average.
_______ I have included and verified at least 120 hours of community service.
_______ I have completely listed all of my activities in at least three Montgomery Blair High School
clubs or activities on the attached activities.
_______ I have included two letters of recommendation. The hard copy is attached in a sealed envelope
or emailed to Mr. Tung Pham at [email protected].
_______ I understand that meeting the minimum requirement does not guarantee acceptance into NHS.
ACTIVITIES OF NATIONAL HONOR SOCIETY:
1. Perform a service project or projects of at least 20 hours each year.
2. Attend all NHS meetings unless excused by advisor, participate in mandatory service project, and
participate in the induction ceremony.
I HAVE READ THE APPLICATION PROCESS AND UNDERSTAND THAT SIGNING THIS
DOCUMENT, I ACCEPT THE APPLICATION PROCESS. I understand that meeting the
minimum requirement does not guarantee acceptance to NHS.
___________________________________
Applicant’s Signature
___________________________________
Parent’s Signature (indicate I have read
the above information)
___________________________________
Date
PLEASE RETURN THIS SIGNED FORM WITH YOUR COMPLETED APPLICATION NO
LATER THAN September 29, 2017.
M O N T G O M E R Y C O U N T Y P U B L I C S C H O O L S
NATIONAL HONOR SOCIETY MONTGOMERY BLAIR HIGH SCHOOL CHAPTER
LETTER OF RECOMMENDATION #1
Please complete this form and return to the student in an envelope. Please be sure to sign
over the seal of the envelope. You may attach a supplementary document or letter. Please
may also return this letter to Mr. Tung Pham in Room 238 or in his mailbox in the main
office by Friday September 29, 2017.
Student Name (Please Print): ________________________________ ID: __________________
Reference Name (Please Print): ______________________________ Position: ________________
Course(s) taught: ______________________________ Year: 9th grade | 10th grade | 11th grade
Please check the appropriate box. Excellent Average Below
Average
No Basis
Leadership
Character
Integrity
Responsibility
Motivation
Class Participation
Willingness to help others
How strongly do you recommend
this student for admission into the
Montgomery Blair chapter of the
National Honor Society?
Highly
Recommend
Recommend Recommend
with
Reservation
DO NOT
Recommend
Additional Comments:
_____________________________________ _______________
Signature Date
M O N T G O M E R Y C O U N T Y P U B L I C S C H O O L S
NATIONAL HONOR SOCIETY MONTGOMERY BLAIR HIGH SCHOOL CHAPTER
LETTER OF RECOMMENDATION #2
Please complete this form and return to the student in an envelope. Please be sure to sign
over the seal of the envelope. You may attach a supplementary document or letter. Please
may also return this letter to Mr. Tung Pham in Room 238 or in his mailbox in the main
office by Friday, September 29, 2017.
Student Name (Please Print): ________________________________ ID: __________________
Reference Name (Please Print): ______________________________ Position: ________________
Please check the appropriate box. Excellent Average Below
Average
No Basis
Leadership
Character
Integrity
Responsibility
Motivation
Class Participation
Willingness to help others
How strongly do you recommend
this student for admission into the
Montgomery Blair chapter of the
National Honor Society?
Highly
Recommend
Recommend Recommend
with
Reservation
DO NOT
Recommend
Additional Comments:
_____________________________________ _______________
Signature Date