STUDENT ACTIVITY INFORMATION FORM

Siren High School National Honor Society

DIRECTIONS: Please complete all sections. (Please type or print-blue or black ink) Do not be modest. Every bit of information can be used by the Faculty Council to assist with the selection process. Completion of this form does not guarantee selection.

I. Administrative Information

NAME_____________________________________________________

ADDRESS___________________________________________________

_____________________________PHONE________________________

PARENT(S)__________________________________________________

Cocurricular Activities—List all activities in which you have participated during high school. Include clubs, teams, musical groups, etc., and major accomplishments in each.

year

ACTIVITY

9

10

11

12

ACCOMPLISHMENTS

II. Leadership Positions—List all elected or appointed leadership positions held in school, community, or work activities. Only those positions in which you were directly responsible for directing or motivating others should be included. For example, elected student body, class or club officer; committee chairperson; team captain; newspaper editor; work area manager; or community leader.

year

ACTIVITY

9

10

11

12

ACCOMPLISHMENTS

III. Service Activities—List volunteer service activities in which you have participated, as a group member or individually. Generally speaking, service activities are those which are done for or on behalf of others (not including immediate family members) for which no compensation (monetary or other) has been given. Please list the name of an adult supervisor who can verify your participation in each activity.

year

ACTIVITY

9

10

11

12

ADULT SPONSOR

IV. Other Community Activities—List other community activities in which you have participated and note any major accomplishment in each. These should be any activities outside of school in which you participated in for the betterment of your community. For example: church groups, clubs sponsored outside of school, Boy or Girl Scouts, or community art endeavors. Do not repeat participation listed above.

year

COMMUNITY ACTIVITY

9

10

11

12

HOURS/WEEK

MAJOR ACCOMPLISHMENTS

SIGNATURE OF ADULT SPONSOR

V. Work Experience, Recognition and Awards—List below any job experiences, honors, or recognition that you have received that support your bid to be selected for membership in the National Honor Society.

year

JOB, RECOGNITION OR AWARD

9

10

11

12

GROUP/ACTIVITY/NUMBER OF HOURS SPENT ON JOB

VI. Goals—In the space provided, briefly describe your future goals ( both high school and after)

VII. NHS MEMBERSHIP---In the space provided, please describe what you feel NHS is all about and why you would like to be chosen as a member.

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I understand that completing this form does not guarantee selection to NHS, and that the information presented here is accurate.

Student Signature Date

I have read the information provided by my son/daughter on this form and can verify that it is true, accurate and complete in its presentation.

Parent Signature Date