Brentwood High School National Honor Society Student Information Form Spring 2019

Student Name 	Grade Level________

Directions: Please complete all sections (print in ink or type). Do not be modest and be as thorough as possible to give the Faculty Council sufficient information to evaluate your candidacy. You may attach additional information sheets if necessary.

Completion of this form does not guarantee selection. This form is only one of the required elements for selection. Please see the Brentwood High School NHS website for additional information on the remaining steps. If you have any questions on the proper completion of this packet, be sure to contact Mrs. Cramer at cramerk@bb-sd.com and/or Mrs. Kiryk at kiryka@bb-sd.com for clarification as soon as possible.

Also, please be aware that school attendance and discipline records will be used by the Faculty Committee as part of the selection process.

Only completed packets will be considered for selection. Since you will have approximately three weeks to obtain the necessary signatures and information for this packet, it is unacceptable to omit required information without previously discussing the situation with Mrs. Cramer and Mrs. Kiryk. Although you may not have enough information to fill in every blank or box below, make this document as comprehensive as possible.

*Although it is not required, it is strongly encouraged that you join the NHS Remind group to stay informed. The directions for joining are on the last page of this packet.

This packet, in its entirety, is due to the main office by 2:45 on Friday, April 5th. This includes the checklist on the last page with a parent’s signature. Faculty rating forms will be distributed to teachers on April 8; therefore, student forms cannot be accepted once the teacher rating form has been created.

I. Service Activities—Individual service hour log sheets should be submitted with this packet of information. You must submit your log of 36 hours of community service with this packet by April 5, including signatures. Service logs can be found at http://www.bb-sd.com/activities_high.asp#nhs. You may also submit a signed letter from an organization you have volunteered with. If earning the 36 hours is an issue, see Mrs. Cramer and Mrs. Kiryk immediately to discuss opportunities to meet the hourly requirements. Service Activity hours cannot be used for Section II., Activities.

II. Activities
In School-List all activities in which you have participated at/for Brentwood High School. Please include clubs, Spartan sports teams, musical groups, etc. Be specific and detail your activities. You should indicate the number of hours dedicated to the activity and the adult sponsor’s signature and phone number. Mr. Huffman’s signature may be obtained for coaches or sponsors not employed by the district and therefore unavailable. Students are expected to be active in a minimum of two school activities.

Activity

Role/Accomplishments
	Approx. hours spent per week in grades
	Signature and Adult Sponsor Contact Information
	
		9
	10
	11
	12

							

Out of School– List any organized activities occurring outside of the school in which you have participated during high school. Be specific and detail your activities. For example, you may include any jobs, church groups, Boy or Girl Scouts, community art endeavors, club/non-Spartan sports teams, etc. You need to include the number of hours dedicated to the activity and the adult sponsor’s signature and phone number. Students are expected to be active in a minimum of one out of school activity. THESE ACTIVITIES CANNOT DOUBLE AS SERVICE HOURS.

Activity

Role/Accomplishments
	Approx. hours spent per week in grades
	
Signature and Supervisor Contact Information
	
		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 responsible for directing or motivating others should be included. Be specific and detail your activities. You need to include a sponsor or supervisor’s signature and contact information.

Activity
	
Leadership Position or Accomplishments
	Approx. hours spent per week in grades
	Signature and Adult Sponsor Contact Information
	
		9
	10
	11
	12

							

IV. Recognition and Awards – List below any honors or recognition that you have received that support your bid to be selected for membership in the National Honor Society. Please do not duplicate any honors or awards previously mentioned on this application. Please obtain the signature and phone number of an adult supervisor (not a parent) who can verify your participation in each activity.

Recognition or Award
	Year Earned
	
Signature and Adult Sponsor Contact Information
	
	9
	10
	11
	12

						

						

V. Required Essay-(typed according to MLA format and attached to this form) In one page explain how your participation in one of the activities listed on this form has helped you to grow into a more responsible, mature person.

VI. If accepted for membership in the National Honor Society, I agree to the following:

1.I will participate in the Induction Ceremony in the evening of May 7, 2019, in the high school auditorium.
2.By the required dates, I will accumulate 36 hours of community service during each year of membership.
3.I will participate in the group service project each year.
4.I will not let my grade point average fall below the cumulative GPA requirements during any semester. 5.I will abide by all school rules, local, state, and federal laws.
6.I understand that failure in any of the above areas is grounds for removal from NHS.

VI. Student Signature

I certify that all election information provided on this form is true and correct to the best of my knowledge and that no repetition of hours for my graduation project and National Honor Society membership exist. I acknowledge that any inaccurate or misleading information will jeopardize my membership privilege. I further certify that I will, if elected for membership, abide by the rules and support the goals of the National Honor Society.

Applicant Signature	Date

The following information will be used only if you are selected for membership.

Please tell us how you would like the invitation(s) for the Induction Ceremony addressed to your parents/guardians. If your parents reside together, you need only complete one. You are welcome to invite other family members and/or friends; however, we will mail invitations to your parents/guardians only.

1. Name (use titles Mr./ Mrs. Ms. Dr.)

Street address

City, State, Zip Code

2. Name use titles (Mr./ Mrs. Ms. Dr.)

Street address

City, State, Zip Code

NHS Information Form Checklist

I have:
 Attached my completed service hour log filled out in ink with signatures.

 Filled out all sections of the packet completely, in ink, including adult/sponsor signatures and contact information.

 Attached my one page essay.

 Given this information form to a parent/guardian to proofread.

Parent/Guardian Signature:_______________________________________ Date:__________________

 Student Signature:_____________________________________Date:________________