1. NORTH ROSE-WOLCOTT CENTRAL SCHOOL


NORTH ROSE-WOLCOTT CENTRAL SCHOOL



NORTH ROSE-WOLCOTT CENTRAL SCHOOL

NATIONAL HONOR SOCIETY QUESTIONNAIRE
FOR ACADEMICALLY ELIGIBLE STUDENTS
 

Name_____________________________ Circle Class: Jr. or Sr.   Date __________________
Mailing Address_____________________________________________________________________
Phone ___________________________ Parent or Guardian __________________________________
 

To Potential National Honor Society Members:

Membership in the National Honor Society is based upon excellence in four areas: scholarship, leadership, service, and character. Each category is judged independently.

To be eligible for membership, a student must have a cumulative average of at least 87%. In addition to the academic requirement, participation and leadership in school and other activities is required. Please complete this questionnaire, answering questions in complete sentences, and hand it to Mrs. Packard by Friday, October 13, 2006.

After students become members of the Honor Society, they are reviewed periodically by the faculty and must maintain the high standards of the Society. Active members in the Honor Society are required to maintain a minimum scholastic average of 87% and to live up to the character, leadership and service ideals of the National Honor Society.

Although you are to be commended for maintaining a high scholastic average, please understand that membership is not guaranteed to anyone. If you do not hand in the questionnaire, you will not be considered. The Faculty Selection Committee makes the final decision for membership. If you have any questions regarding the Society or membership, please contact me.

             Sincerely,

             Mrs. Barbara Packard

             NATIONAL HONOR SOCIETY ADVISOR

 
Please list the name and phone numbers of the people you would like contacted, if you are elected.
 

 
Name
Phone
Mother    
Father    
Guardian    
Stepmother    
Stepfather    

 

Please fill in the following activity chart. Include events you have participated in since you started ninth grade.
 
Membership in clubs, activities and on teams, both in and out of school Number of years a member Year in school
9,10,11,12 		List of offices, committee responsibilities, special tasks, etc. in the club, activity, or on the team
Art Club      
Chess Club      
Class Officer/Class Activities      
FFA      
FBLA      
Foreign Exchange Programs      
Interact      
Interscholastic Sports (list sport)
(list sport) 		     
       
       
Intramural Sports      
Library Club      
MasterMinds      
Musical/Drama Production      
Peer Mediator      
SADD      
Science E Corps      
Ski Club      
Student Council      
Student Guide      
Varsity Club      
Yearbook      
Youth to Youth      
4-H      
Scouting      
Church Groups      
Awards and Honors
 
 
 
 
  		 
 
   		    
 
   
OTHER groups and
anizations 		     
     Organizations:        
       
       
       

 
 
 
The North Rose-Wolcott Chapter of the National Honor Society upholds the following characteristics:
1.   Leadership
a)  Participates positively in class discussions.
b)  Is dependable in fulfilling any responsibility he/she accepts.
c)  Successfully holds offices and/or positions of responsibility.
d)  Demonstrates leadership in school and community activities.
e)  Exerts leadership that influences others for good.
 
In what ways do you feel that you demonstrate leadership? Be specific.
 
 
 
 
 
 
 
 
 

 
2. Service :
a)  Volunteers to help or responds willingly when asked.
b)  Works on class or club projects or committees.
c)  Complete the job he/she undertakes.
d)  Helps fellow students, teachers, and other people.
e)  Renders service to the school and/or to the community.
 
In what ways have you demonstrated service? Be specific.
 
 
 
 
 
 
 
 
 

 

3.   Character :
a)  Demonstrates highest standards of attitude toward honesty and reliability.
b)  Demonstrates desirable qualities of personality, such as cheerfulness, friendliness, neatness, poise, stability.
c)  Shows courtesy to others in school, at school activities and in the community.
d)  Upholds principles of morality and ethics.
e)  Cooperates by complying with school regulations.
 
What do you feel are your strengths of character?
 
 
 
 
 

 
In what ways do you feel that membership in the National Honor Society could benefit you? What are your reasons for considering membership in NHS?
 
 
 
 
 

 

3.  NHS meetings are mandatory. Will you accept the responsibility of being at all NHS meetings, possible evening meetings? ______

4.  Would you be willing to participate in activities that the majority of the group might vote to undertake? ________________

5.  Each NHS member is expected to complete 25 hours of community service. Do you intend to fulfill this responsibility if elected? ___________

6.  I understand that completion of this form does not guarantee membership, but that I am being considered for membership in the National Honor Society. I will accept the decision of the Faculty Committee charged with the responsibility of selecting members as final. (Initial here: _________)

7.  Please obtain the signatures of two teachers whom you feel know you well enough to write a letter of recommendation for you. Please provide each teacher with an envelope (with your name on it) addressed to Mrs. Packard for the letter of recommendation. Ask them to give it directly to her.

1)._____________________________________ 2)._____________________________________

8.  Obtain one letter of recommendation from someone outside of school who knows you well. They should comment on your character, leadership and service. This person cannot be related to you. This letter needs to be in a sealed envelope and be submitted with your application.

 
Student’s Signature: _________________________________________________________________________

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