National Junior Honor Society Character, Service, Scholarship, Leadership, and Citizenship Membership and Information Form

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1 Membership and Information Form Name (Print): Team: Student ID #: Counselor: COMPLETE APPLICATIONS ARE DUE TO THE MAIN GUIDANCE OFFICE LATER THAN 4:00PM TUESDAY, MARCH 22,

2 1. Have you completed at least one full semester at Larkspur Middle School? 2. Did you receive a CUMULATIVE 3.5 grade point average or higher for the FIRST SEMESTER this school year? 3. Are you willing to attend National Junior Honor Society meetings a minimum of twice a month AFTER &/or BEFORE SCHOOL? 4. Are you willing to donate at least ten service hours each semester for a total of 20 service hours during next school year? 5. Do you understand that SCHOLARSHIP (your 3.5 or above GPA) is only one of five important requirements for membership in National Junior Honor Society, the other four being LEADERSHIP, SERVICE, CHARACTER, and CITIZENSHIP? 6. Are you willing to acquire one letter of recommendation from all current core subject teachers and one letter from an adult who is T a family member? Student Signature Date Parent Signature Date 2

3 Please list specific activities that represent the below listed qualities in you. Be specific. Include any awards that you may have received (such as Honor Roll, Perfect Attendance, Bug Roll, or Principals of American Citizenship). Some activities may be entered in more than one category. You must have AT LEAST ONE ACTIVITY FROM MIDDLE SCHOOL IN EVERY CATEGORY to be considered for membership. Attach a separate page if necessary. CATEGORIES: SCHOLARSHIP: In order to be eligible for the National Junior Honor Society, you must have a minimum 3.5 GPA. LEADERSHIP: Taking the initiative to train and aid others to attain the same objective Activity Grade Level of Description Timeframe or Number of Hours of Printed Name and Signature of Adult Adviser 3

4 SERVICE: Volunteering time, talent, and abilities to benefit those in need in school or in the community Activity Description Grade Level of Timeframe or Number of Hours of Printed Name and Signature of Adult Adviser CHARACTER: The force within each individual which distinguishes that person from others Activity Grade Level of Description Timeframe or Number of Hours of Printed Name and Signature of Adult Adviser 4

5 CITIZENSHIP: The responsibilities each of us has to our home, school, or community. Activity Description Grade Level of Hours of Printed Name and Signature of Adult Adviser 5

6 Give this form to a current core teacher to fill out and return directly to Mrs. Wolford CURRENT MATH TEACHER TUESDAY, MARCH 22 nd Math 6

7 Give this form to a current core teacher to fill out and return directly to Mrs. Wolford CURRENT ENGLISH TEACHER TUESDAY, MARCH 22 nd English 7

8 Give this form to a current core teacher to fill out and return directly to Mrs. Wolford CURRENT SCIENCE TEACHER TUESDAY, MARCH 22 nd Science 8

9 Give this form to a current core teacher to fill out and return directly to Mrs. Wolford CURRENT SOCIAL STUDIES TEACHER TUESDAY, MARCH 22 nd Social Studies Give this form to an adult of your choice (non-family member) to fill out & return in a sealed envelope to Mrs. Wolford. 9

10 ANY ADULT- N FAMILY MEMBER TUESDAY, MARCH 22 nd _ 10

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