National Honor Society Application Form · NATIONAL HONOR SOCIETY CONTRACT As a member of the Dallastown Area High School National Honor Society, you must fulfill the following requirements:

National Honor Society - Dallas Imperial Chapter - Dallastown Area High School

National Honor Society Application Checklist

Personal data page

Contract

Signature page

Leadership personal statement

School Activity form

Community service form

Three teacher/school counselor recommendation forms – complete the top

portions only and deliver to your recommending teacher

Deliver to Ms. Lehr in Room 206 or Mrs. Rose-Mulder in Room 259

Dallastown Area High School NHS Criteria Rubric

Criteria Description Evidence Possible Points Score

LEADERSHIP

Leadership is based on Personal Statement and Student Activities form

Student demonstrates leadership through active membership in clubs, activities or sports. One of the activities must be a school activity. Leadership skills and involvement are clearly identified in activities over an extended period of time.

Personal Statement EXCEEDS: Provides thorough explanation of leadership activity. MEETS: Statement shows relevant and sufficient examples of student leadership. BELOW: Statement does not relate to the question and contains no example of leadership in action.

3 points

2 points

1 point

Activities EXCEEDS: Student participates in 3 or more activities. At least 2 activities are for a year or more.

MEETS: Student participates in 2 activities. At least 1 activity is for a year or more.

BELOW: Student participates in 1 or less activity and/or activity participation is for one semester.

3 points

2 points

1 point

SERVICE Student shows evidence of service performed in school and/or community.

76 – 100+ hours 51 – 75 hours 1 – 50 hours

6 points 4 points 2 points

CHARACTER

Character is based on three teacher/school counselor

recommendations

Student shows evidence of exemplifying the seven desirable qualities of character: respectful, mature, responsible, fair, trustworthy, honest, good citizen.

Recommend without reservation

Recommend with

reservation

2 points per recommendation

1 point per recommendation

Total Points __________________

A total of 12 points out of 18 points is expected for acceptance into National Honor Society.

Dallastown Area High School National Honor Society Application

Personal Data Name: __________________________________________________________________________________________________ Last First Middle Address: ________________________________________________________________________________________________ Number and Street _________________________________________________________________________ City and State Zip Code Home Telephone: _______________________________________ Cellular Telephone: _______________________________ E-mail:____________________________________________________________________________________ General Directions: Use the checklist to be sure all parts of the application are included. Follow the specific directions on each page. Incomplete applications will not be reviewed. Return your completed application to Ms. Lehr or Mrs. Rose-Mulder. Teacher Recommendations: In the spaces below, name the three teachers you will ask to recommend you. Complete the table. A recommendation must be given to a teacher whose class you have taken or are currently taking. You may also ask your school counselor. You cannot use a coach, activity sponsor, or non-teaching staff person.

Teacher Course Semester /Year

Questions: If you have questions or need help completing the application, you may contact one of the following advisors: Ms. Heather Lehr Room 206 [email protected] Mrs. Connie Rose-Mulder Room 259 [email protected]

PARENT/GUARDIAN AND STUDENT STATEMENT OF UNDERSTANDING

We understand that membership in the Dallastown Area High School chapter of the National Honor Society is a privilege. We understand that the criteria for membership include student leadership, community service, scholarship, and character in accordance with the national organization. We understand that the completion of the application for membership places a student into consideration for membership. In accordance with the guidelines and charter of the NHS, the Faculty Council decisions are confidential.

NATIONAL HONOR SOCIETY CONTRACT As a member of the Dallastown Area High School National Honor Society, you must fulfill the following requirements:

1. Complete a minimum of 20 hours of NHS-based service projects per year 2. Attend the induction for new members 3. Attend NHS meetings (one per month) 4. Maintain a 4.3 cumulative GPA 5. Submit $15 dues within 30 days of the induction ceremony

Financial need will not impact your eligibility to be a member of the NHS at Dallastown. Please indicate any need for financial assistance for NHS membership.

By signing this contract and participating in the induction ceremony of the National Honor Society, you agree to the standards for membership and to uphold the four values of the National Honor Society and the Dallas Imperial Chapter, which are to participate and demonstrate leadership in the areas of scholarship, service, leadership, and character. Student Name: __________________________________________________________________________ (Printed) Student Signature: _______________________________________________________________________ (Signature) Parent/Guardian Name: ___________________________________________________________________ (Printed) Parent/Guardian Signature: ________________________________________________________________ (Signature)


Signature Page To be completed by the applicant: I understand that completing and submitting this application does not guarantee selection to the National Honor Society. I attest that the information presented here is complete and accurate. Name: _______________________________________________________ Date: ________________ (Printed) Signature: ____________________________________________________

To be completed by the parent or guardian of the applicant: I have reviewed the application and give permission for my child to apply to the Dallastown Area High School, Dallas Imperial Chapter of the National Honor Society. Name: _______________________________________________________ Date: ________________ (Printed) Signature: ____________________________________________________ Daytime Telephone: ___________________________ E-mail: ___________________________________


Leadership Personal Statement

Directions: Please answer the following question. This personal statement must be TYPED in the space below. This statement cannot exceed 250 words.

How do you see yourself as a leader? Describe an activity or experience in which your participation made a difference. How did your leadership skills influence the outcome? Give examples. You may include job experiences, honors, recognitions, and/or awards.

Student Name: ___________________________________________________________________


School Activity Form (considered under Leadership Rubric)

Directions: List all activities in which you have participated during high school. Include clubs, teams, musical groups, etc. Please include any major accomplishments for an activity (ex. Captain, director, etc.). Also note the name of the faculty coordinator/advisor you work with in this activity.

ACTIVITY YEAR

(9th, 10th, 11th) Accomplishment Faculty Coordinator/Advisor

Student Name: ___________________________________________________________________


Community Service Form

Directions: Complete this page for your one or two most meaningful unpaid community service experiences. Ask each sponsor to describe your service, confirm your length of service, comment and sign a letter on the letterhead stationery of the organization. Include the letter(s) with your application.

Student Name: ___________________________________________________________________

1. Organization: ____________________________________________________________________________________________

Address: ________________________________________________________________________________________________

________________________________________________________________________________________________

Telephone: ___________________________ E-mail:__________________________________________________________

Dates of Service: __________________________________ Total Hours of Service: ___________________________________

Sponsor Signature: _______________________________________________________________________________________

Sponsor Title: ______________________________________ Sponsor E-mail:_______________________________________ _________________________________________________________________________________________________________ 2. Organization: ____________________________________________________________________________________________

Address: ________________________________________________________________________________________________

________________________________________________________________________________________________

Telephone: ___________________________ E-mail:__________________________________________________________

Dates of Service: __________________________________ Total Hours of Service: ___________________________________

Sponsor Signature: _______________________________________________________________________________________

Sponsor Title: ______________________________________ Sponsor E-mail:_______________________________________


Teacher Recommendation Form

Applicant: Complete the top portion only. Student Name: ___________________________________________ Teacher Name: ___________________________________________

This student is seeking to become a member of the National Honor Society. The Faculty Council would like your input to help make its decision. What course did you teach this student and when? _________________________________________________ Check the appropriate box that best describes the character of the student.

Attribute Excellent (Top 10%)

Good Average Below

Average No Basis for Judgment

Responsibility

Maturity and self-discipline

Concern for others

Integrity

Reaction to setbacks

Initiative, independence

Cooperation with others

Disciplined work habits

Leadership

Recommendation: _____ recommend without reservation

_____ recommend with reservation (Please comment below) Comments:________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

Signature __________________________________________________________________ Printed Name ______________________________________________________________ Date _______________________

DO NOT RETURN TO THE APPLICANT.

Please sign and return to the mailbox of Mrs. Rose-Mulder. Thank you.






Good Average Below


Responsibility


Concern for others

Integrity





Leadership



_________________________________________________________________________________________________________

_________________________________________________________________________________________________________









Good Average Below


Responsibility


Concern for others

Integrity





Leadership



_________________________________________________________________________________________________________

_________________________________________________________________________________________________________





School Counselor Recommendation Form

Applicant: Complete the top portion only. Student Name: ___________________________________________ School Counselor Name: ___________________________________________

This student is seeking to become a member of the National Honor Society. The Faculty Council would like your input to help make its decision. Check the appropriate box that best describes the character of the student.


Good Average Below


Responsibility


Concern for others

Integrity





Leadership


_____ recommend with reservation (Please comment) Comments:________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________




Dallastown Area High School

National Honor Society Application

OPT OUT FORM

To be completed by the applicant: I do not wish to be a member of the National Honor Society. Name: _______________________________________________________ Date: ________________ (Printed) Signature: ____________________________________________________ To be completed by the parent or guardian of the applicant: I understand that my child does not wish to be a member of the National Honor Society. Name: _______________________________________________________ Date: ________________ (Printed) Signature: ____________________________________________________

Documents

National Honor Society Application Form · NATIONAL HONOR SOCIETY CONTRACT As a member of the Dallastown Area High School National Honor Society, you must fulfill the following requirements: