Any item not signed or verified by a qualified sponsor will be disregarded.

III.
Remember to read all directions carefully! SERVICE List all service activities. This category is not for membership in clubs or on teams. Any activity in which you have served the school community would qualify for this section. For example, helping a teacher or tutoring fellow students, managing a team or participating in spirit activities, or working at concession stands or selling tickets would be appropriate for this category. Include hours that go beyond what may be required for Student Council, band, sports, and other activities. Start with the most recent service and work backwards. If you have provided the same service for more than one year, please complete one box and check the appropriate grade levels.

GRADE SERVICE 9 10 11 12 PURPOSE total hours

_______________________________________ Sponsor’s name SERVICE 9

_______________________________________ Sponsor’s signature total hours

10 11 12 PURPOSE

_______________________________________ Sponsor’s name SERVICE 9

_______________________________________ Sponsor’s signature total hours

10 11 12 PURPOSE Spent one afternoon after school and helped out at mid-semester parent teacher conferences. Helped parents organize miniappointments with each teacher and pointed other parents where exactly to go in order to meet all of their student’s teachers.

3.

Conferences

X

_______________________________________ Sponsor’s name SERVICE 9

_______________________________________ Sponsor’s signature total hours

10 11 12 PURPOSE

_______________________________________ Sponsor’s name SERVICE 9

_______________________________________ Sponsor’s signature total hours

10 11 12 PURPOSE

_______________________________________ Sponsor’s name

_______________________________________ Sponsor’s signature

SERVICE

9

10 11 12 PURPOSE

total hours

6.

_______________________________________ Sponsor’s name SERVICE 9

_______________________________________ Sponsor’s signature total hours

10 11 12 PURPOSE

7.

_______________________________________ Sponsor’s name

_______________________________________ Sponsor’s signature

SERVICE

9

10 11 12 PURPOSE

total hours

8.

_______________________________________ Sponsor’s name

_______________________________________ Sponsor’s signature

Attach additional pages if necessary.

Any item not signed or verified by a qualified sponsor will be disregarded.
IV.

Remember to read all directions carefully! EXTRACURRICULAR SCHOOL ACTIVITIES List all activities in which you have participated at school. Include clubs, teams, musical groups, etc., as well as major accomplishments in each. Start with the most recent activity and work backwards. If you have participated in the same activity for more than one year, please complete one box and check the appropriate grade levels. GRADE

ACTIVITY 1. Debate Team

9 X

1 0 X

1 1

1 2

PURPOSE This has been one of the main focal points of my high school career, spanning since the beginning of freshman year until the end of high school (hopefully). This is a biweekly commitment meaning that the moment I leave school on Friday to Saturday evening during a tournament weekend is 100% devoted to debate. Behind academics, forensics is my number one concern during the season.

total hours

_________________________________________ Sponsor’s name ACTIVITY 9 1 0 1 1 1 2

______________________________________ Sponsor’s signature PURPOSE total hours

_________________________________________ Sponsor’s name

______________________________________ Sponsor’s signature

ACTIVITY

9

1 0

1 1

1 2

PURPOSE

total hours

_________________________________________ Sponsor’s name ACTIVITY 9 1 0 1 1 1 2

______________________________________ Sponsor’s signature PURPOSE total hours

_________________________________________ Sponsor’s name

______________________________________ Sponsor’s signature

Any item not signed or verified by a qualified sponsor will be disregarded. V. LEADERSHIP POSITIONS List all elected or appointed leadership positions held in school or community 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; or community leader. Start with the most recent leadership experience and work backwards. If you have provided the same leadership for more than one year, please complete one box and check the appropriate grade levels. GRADE Leadership Position 9 10 11 12 Activity or Purpose or Sponsor's signature Organization Accomplishment

2. Chairperson

X

I was chosen to be a chairperson for Nuevos Amigos 2010-2011, meaning that I will be Nuevos Amigos leading a fairly large group in welcoming new students and making club decisions as well.

3.

Attach additional pages if necessary

Any item not signed or verified by a qualified sponsor will be disregarded.
VI. COMMUNITY ACTIVITIES List community activities in which you have participated and note accomplishment or purpose for each. These should be any activities outside of school that functioned for the betterment of your community. For example, you can include church groups, clubs sponsored outside the school, Scouts, volunteer groups, or other community endeavors. Please note that this category cannot replace the school service that is a requirement for membership. Start with the most recent service and work backwards. If you have provided the same service for more than one year, please complete one box and check the appropriate grade levels. ACTIVITY 9 10 11 12 accomplishment total Sponsor's / purpose hours name Volunteered 4 hours a week every Sunday to gain experience about X the medical profession and to help out the community as well. Sponsor's signature Sponsor's phone #

Hospital Volunteering (Pharmacy)

REMEMBER: • Due date: on or before 3 P.M., Friday, February 19, to Mrs. Kiser (3312). • You have received this Student Information Form because your career GPA of 3.6 or higher qualifies you to be eligible for membership. You must complete and submit this form on or before the due date in order to be considered for NHS membership. • Please read and follow all directions. • Attach a recent photo in the space provided on page one of this form. • Make a copy of your 1st semester report card and attach it to this form. • Attach additional sheets if you need more space for honors, or service, extracurricular, leadership, or community activities. • Carefully proofread your form. You are being considered on the basis of the information that you submit as well as what your teachers say about you on the faculty evaluation form. • Make a copy of your completed form. The information that we require is similar to the information that you will be asked to supply on college applications and scholarship requests. After the selection process is completed, all forms are destroyed. • You will be notified by mail in March to indicate whether or not you have been accepted.

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