National Honor Society: Candidate Information Form For Juniors

National Honor Society
ID #_____________
Southington High School Chapter
Candidate Information Form for Juniors
National Honor Society ID #_____________

Candidate Information Form for Juniors

Directions: Please fill out this form using black or blue ink or by typing it. Remember to include
your student ID # on every page and your name only where indicated. Please fully complete all
sections, including signatures if required. Do not be modest. Every piece of information can be
used by the National Honor Society Faculty Committee to assist with the selection process.
Completion of this form does not guarantee selection.
Administrative Information
Name:
Address:
Name of Parents/Guardians:
Home Phone:
Period 1Teacher:
Email Address:
2022 Candidate Information Form for Juniors 1 2/25/22

ID #_____________
Service Activities: School, Community (at least 20 hours), Work/Life Experience
Any activity that you earn a high school credit for does NOT count (i.e. Marching Band,
Orchestra, Project Lead The Way, GHAMAS, etc.). Leadership positions in those activities can
count towards leadership but classes are not considered activities.
Must have at least one leadership position – elected or appointed – can include being a class
officer, team captain, chairperson of a committee for a school sponsored club (i.e. chairing a bake sale),
or any position in which you have been responsible for directing or motivating others.
A. School Activities: (2 or more PER YEAR) Required

List all the activities that you have participated in during your high school career. You must have been involved in at least
two activities in the Southington High School community for each year that you have attended. Include clubs, teams,
musical groups, etc. and major accomplishments in each. You may only include activities that were not part of a class
requirement and for which you did NOT receive credit or a grade. It is important to include the years in which you
participated, starting with those with which you have the longest standing. You must provide the name of your adult sponsor
or advisor and their signature, and a valid phone number. If we are not able to verify your involvement as stated, your
service will not be considered as part of your form.
Activity Year(s) Total Phone Number Signature

9 10 11 Hours Sponsor/Advisor
☐ ☐ ☐
Ext.
Comments: Name Printed:
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.

ID #_____________
B. Community Activities: Required

List all the activities that you have participated in outside Southington High School during your high school career. These
can include activities that you perform for the community or your church, such as Bread for Life, Southington Social
Services, Southington Public Library, etc. List any honors or recognitions that you have received which support your
candidacy to be selected for membership in the National Honor Society. You must provide the name of your adult
supervisor, their signature, and a valid phone number. If we are not able to verify your involvement as stated, your
service will not be considered as part of your form.
Activity Year(s) Total Phone Number Signature Honors/Awards

9 10 11 Hours Director/Organization
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.

ID #_____________
Work/Life Experiences: not required

Please list below any work or life experiences you have had and any honors or recognitions that you have received that
support your candidacy for membership in the Honor Society. These experiences may be paid or volunteer and may include
a job, educational enrichment activities, service trips, study abroad/exchange programs, etc. You must provide the name of
your adult supervisor, their signature, and a valid phone number. If we are not able to verify your involvement as stated,
your service will not be considered as part of your form.
Activity Year(s) Total Phone Number Signature

9 10 11 Hours Sponsor/Advisor
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.
☐ ☐ ☐
Ext.

ID #_____________
Leadership: Required
Please list and describe below any leadership position you have held in the above positions or in the classroom. Explain
what you did, for whom, when, for how many hours, whom you led, how you obtained the position, etc.
Leadership position Year(s) Phone Number Signature

Sponsor/Advisor
Ext.
Ext.
Ext.
Ext.

ID #_____________
Character: (Essay)
Please type the following essay, using double spacing and font size 12. This should not be longer than one page. Please
include your ID # only on the essay. In 300 words or less, explain why you believe that you should be considered for
membership into the Southington High School chapter of the National Honor Society. Your explanation should focus on
character and how you have demonstrated this characteristic during your high school career. The National Honor Society
defines character as follows.
Character: The student of good character upholds principles of morality and ethics, is cooperative, demonstrates
high standards of honesty and reliability, shows courtesy, concern, and respect for others, and generally maintains
a good and clean lifestyle.


ID #_____________
PLEASE READ THIS STUDENT AGREEMENT ("AGREEMENT") CAREFULLY BEFORE

SUBMITTING YOUR FORM TO THE SOUTHINGTON CHAPTER OF THE NATIONAL
HONOR SOCIETY (“THE CHAPTER”). BY SUBMITTING YOUR FORM, YOU ARE
AGREEING TO BE BOUND BY THE TERMS OF THIS AGREEMENT AND THE BYLAWS
FOR THE CHAPTER. SIGNIFY YOUR ACCEPTANCE TO BE BOUND BY THE TERMS OF
THIS AGREEMENT AND THE CHAPTER BYLAWS BY CHECKING THE
"AGREE/ACCEPT" BOX AND RETURNING THE FORM ON OR BEFORE THE
DEADLINE. IF YOU DO NOT AGREE TO THE TERMS OF THIS AGREEMENT AND/OR
THE CHAPTER’S BYLAWS, DISCARD THIS FORM OR SIGNIFY BY SELECTING
"DISAGREE/DECLINE" AND YOUR FORM WILL BE WITHDRAWN FROM
CONSIDERATION BY THE CHAPTER. PLEASE PRINT AND SIGN YOUR NAME BELOW.
1. General. Completion of this form does not ensure acceptance into the Southington Chapter of the
National Honor Society. This form along with your academic records and faculty input will be
evaluated by a faculty advisory board to determine if you will be accepted into the Southington
Chapter of the National Honor Society.
2. Form. This form must be completed and returned on or before the due date to the Southington
Chapter of the National Honor Society Advisor. You must ensure that all of the information on your
form is factual to the best of your ability. The faculty advisory board, when determining your
eligibility, will not consider any information found to be false. You must review this form and its
contents with your parents or legal guardian.
3. Member in Good Standing. A Member in Good Standing is a member that continues to
demonstrate a pattern of service, leadership, character and academics. Reference the
Southington Chapter of the National Honor Society bylaws for Member in Good Standing
requirements. Members inducted in the Fall of their senior year must have a minimum of 25 hours
of service. Of these a minimum of 15 hours must be NHS event hours plus a minimum of 5 hours
of tutoring within Southington High School for a total of 20 NHS hours.
4. Dismissal. If it is found that after your acceptance into the Southington Chapter of the National
Honor Society there is false information on your form you will be considered for dismissal by the
Faculty Advisory Board. Any flagrant violation of the bylaws may also result in dismissal by the
faculty council.
☐ Agree/Accept ☐ Disagree/Decline
NAME_______________________________________________________
SIGNATURE__________________________________________________

ID #_____________
PLEASE READ THIS PARENT AGREEMENT ("AGREEMENT") CAREFULLY BEFORE

YOUR CHILD SUBMITS THIS FORM TO THE SOUTHINGTON CHAPTER OF THE
NATIONAL HONOR SOCIETY (“THE CHAPTER”). BY SUBMITTING THIS FORM, YOU
ARE AGREEING TO BE BOUND BY THE TERMS OF THIS AGREEMENT. SIGNIFY YOUR
ACCEPTANCE TO BE BOUND BY THE TERMS OF THIS AGREEMENT BY CHECKING
THE "AGREE/ACCEPT" BOX. IF YOU DO NOT AGREE TO THE TERMS OF THIS
AGREEMENT, DISCARD THIS FORM OR SIGNIFY BY SELECTING
"DISAGREE/DECLINE" AND YOUR CHILDS FORM WILL BE WITHDRAWN FROM
CONSIDERATION BY THE CHAPTER. PLEASE PRINT AND SIGN YOUR NAME BELOW.
1. General. Completion of this form does not ensure your child’s acceptance into the
Southington Chapter of the National Honor Society. This form along with your child’s
academic records and faculty input will be evaluated by a faculty advisory board to
determine acceptance into the Southington Chapter of the National Honor Society.
2. Form. You have reviewed this form with your child and to the best of your knowledge
have determined that the information contained within this form is factual.
3. Bylaws. You have reviewed the bylaws of the Southington Chapter of the National Honor
Society and are willing to supply the necessary support and encouragement in order for
your child to remain a Member in Good Standing.
☐ Agree/Accept ☐ Disagree/Decline
NAME_______________________________________________________
SIGNATURE__________________________________________________
NHS maintains policies and practices that are designed to prevent discrimiation against any qualified
candidate or member on the basis of race, color, religion, ancestry, national origin, gender, and
disability. This policy of nondiscrimination applies to all practices, including the chapter
administration and the selection, discipline, and dismissal of members.

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National Honor Society

National Honor Society ID #_____________

Candidate Information Form for Juniors

2022 Candidate Information Form for Juniors 1 2/25/22

Service Activities: School, Community (at least 20 hours), Work/Life Experience

A. School Activities: (2 or more PER YEAR) Required

Activity Year(s) Total Phone Number Signature

2022 Candidate Information Form for Juniors 2 2/25/22

B. Community Activities: Required

Activity Year(s) Total Phone Number Signature Honors/Awards

2022 Candidate Information Form for Juniors 3 2/25/22

Work/Life Experiences: not required

Activity Year(s) Total Phone Number Signature

2022 Candidate Information Form for Juniors 4 2/25/22

Leadership position Year(s) Phone Number Signature

Comments: Name Printed:

Comments: Name Printed:

2022 Candidate Information Form for Juniors 5 2/25/22

2022 Candidate Information Form for Juniors 6 2/25/22

PLEASE READ THIS STUDENT AGREEMENT ("AGREEMENT") CAREFULLY BEFORE

2022 Candidate Information Form for Juniors 7 2/25/22

PLEASE READ THIS PARENT AGREEMENT ("AGREEMENT") CAREFULLY BEFORE

2022 Candidate Information Form for Juniors 8 2/25/22

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