Eleanor Roosevelt High School: National Honor Society Application

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1 Eleanor Roosevelt High School: National Honor Society Application Full Name Do Not Write in This Space-NHS Faculty Use Address City, State, Zip Date Application Received Date Application Reviewed Phone Membership Status Accepted/Declined ID & Grade Level The criteria for election to the National Honor Society (NHS) are: Date of Notification Scholarship Character Leadership Service Minimum requirements for NHS membership can be found on the school s website under Activities and NHS. Your academics will determine whether you have met the requirements for Scholarship. The standards of Character, Leadership and Service will now be reviewed in a variety of ways (this packet, the ERHS faculty, the NHS faculty selection committee). Complete this application packet. Use only the space provided. Please type your essay using Times New Roman, 12 point font, single-spaced, and words. Essays may be attached to the application as an additional page. Ask four (4) of your teachers to recommend you for NHS by filling out the brief evaluation form. Make sure you and a parent read, sign and turn in the packet. Attach current transcripts to this packet. Have a club advisor, employer, or a teacher for whom you have worked for (tutor, teacher assistant, volunteer) complete the Character, Leadership, and Service Evaluation Form. SIGNATURE FORM I have read this packet and to the best of my knowledge have completed the attached information packet. I understand that returning this information packet puts my name in consideration for membership but does not guarantee an invitation to become a member. Student Signature Signature of Parent/Guardian Date ERHS NHS Application, 08/11 Page 1 of 6

2 Student Name: ID: EXTRACURRICULAR ACTIVITIES (Please list your extracurricular activities in the order of their interest to you. Include specific events and/or major accomplishments such as musical instrument played, varsity letters earned, etc.) Activity Description Positions held ACADEMIC HONORS AND LEADERSHIP AWARDS (Briefly describe any other scholastic distinctions or leadership honors you have won or earned beginning with ninth grade, such as science fairs or departmental awards.) COMMUNITY SERVICE (Include activities undertaken which were done on behalf of others without any material compensation to the individual performing the service.) OTHER ACTIVITIES, HOBBIES, WORK EXPERIENCE ERHS NHS Application, 08/11 Page 2 of 6

3 Student Name ID PERSONAL STATEMENT The personal statement is a very important part of this application in that it helps us become acquainted with you in ways different from courses, grades, test scores, and other objective data. It enables you to demonstrate your ability to organize thoughts and express yourself. This essay must be typed, single-spaced, Times New Roman, 12-pt. font, and needs to be between words. You may type the essay on a separate sheet and attach it to this packet. We know you are a successful student. Tell us more about who you are as a person what makes you different or unique? How do you exemplify scholarship, service, leadership, and character? My signature below indicates that all information in my application is complete, factually correct, and honestly presented. Signature Date ERHS NHS Application, 08/11 Page 3 of 6

4 You will need four (4) teacher recommendations. Please make four copies of this page for your teachers. Teacher Recommendation Form Student Applicant s First and Last Name: Grade Level: ID: Teachers: Thank you for filling out this recommendation for the above named student who is applying to Eleanor Roosevelt s chapter of National Honor Society. As established by the national charter, in order to become a member, a student must not only excel in scholarship, but also in leadership, character, and service. We ask that you rank this student on these four areas. Please check the box that is appropriate. Scholarship Character Leadership Service Outstanding Good Fair Poor Unable to Judge What comes to mind when you think of this student? Is there anything else you would like us to know about this student? If you marked poor in the chart above - please explain. Additional Comments: Teacher Name: Signature: Date: Thank you for your time. Please return this evaluation to the student in a sealed envelope or to F132 Office within 5 days. ERHS NHS Application, 08/11 Page 4 of 6

5 This form is to be filled out by a club advisor, employer, or teacher for whom you have worked for (tutor, teacher aid, volunteer). Character, Leadership, and Service Evaluation Form Student s Full Name School/Grade Instructions: Please check one statement in each category that best describes the applicant s attitude and performance. Additional comments are welcome! After you have completed this rating please return it within five (5) days to the applicant in a sealed envelope or to Eleanor Roosevelt High School, 7447 Cleveland Avenue, Eastvale, California 92880, Attention: National Honor Society Faculty Council, Kim Lu. LIST STUDENT S JOBS/ACTIVITIES/CLUBS/AWARDS: 1. PUNCTUALITY ALWAYS ON TIME USUALLY ON TIME FREQUENTLY LATE: No. of Days: 2. ATTENDANCE OUTSTANDING SELDOM ABSENT FREQUENTLY ABSENT: No. of Days 3. PERSONAL APPEARANCE ALWAYS APPROPRIATE FOR JOB OCCASIONALLY NOT APPROPRIATE APPROPRIATE DRESS NEEDS TO BE DISCUSSED NOTE WHY: 4. ATTITUDE TOWARDS LEARNING IS ENTHUSIASTIC; COOPERATIVE; EAGER TO DO A GOOD JOB GENERALLY COOPERATIVE RELUCTANT TO DO MORE THAN HAS TO UNCOOPERATIVE; PUTS OUT LITTLE EFFORT 5. ATTITUDE TOWARD SUPERVISION/WORKING W/PEERS PROFITS BY SUGGESTIONS HAS DIFFICULTY ACCEPTING SUGGESTIONS DOES NOT ACT ON SUGGESTIONS GIVEN 6. RELATIONS WITH OTHERS/ADULTS IS COURTEOUS AND CONSIDERATE OF OTHERS SHOULD BE MORE CONSIDERATE HAS BEEN DISCOURTEOUS/RUDE 7. INITIATIVE INITIATES TASKS; IS SELF-DIRECTED REQUIRES NORMAL DIRECTION MUST HAVE CONSIDRABLE DIRECTION 8. JOB PERFORMANCE IS ACCURATE; ATTENTIVE TO DETAILS USUALLY ACCURATE AND RELIABLE OUTPUT IS UNSATISFACTORY OVERALL RATING 5 EXCELLENT 4 GOOD 3 AVERAGE 2 IMPROVEMENT NEEDED IN SOME AREAS 1 UNSATISFACTORY Would you recommend this student for Eleanor Roosevelt High School s National Honor Society? YES YES, with hesitation (Please explain below.) NO ADDITIONAL COMMENTS IF APPLICABLE: Advisor s Name Title Date Advisor s Signature Company ERHS NHS Application, 08/11 Page 5 of 6

6 Eleanor Roosevelt High School s National Honor Society Application Checklist Please turn in your completed application packet by the due date. The application packet must include: Completed application word essay typed, single-spaced, Times New Roman, 12 point font Most current transcripts Four (4) completed and signed teacher evaluations Character, Leadership, Service Evaluation Form to be completed and signed by a club advisor, employer, or teacher who can evaluate your character, leadership, and service outside of the classroom. NOTE: A $25.00 membership fee will be due once a student has been accepted. National Honor Society applications are accepted once a year, usually within the first 60 days from the start of school. Completed applications will be turned in to Eleanor Roosevelt High School s National Honor Society Faculty Council in Building F132. Application deadlines will be posted on the school s NHS webpage. If you have further questions, please contact Mrs. Kim Lu, Assistant Principal, in Building F132, or Mr. Vincent Flores, NHS Faculty Advisor.. ERHS NHS Application, 08/11 Page 6 of 6

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