CAPITAL HIGH SCHOOL NATIONAL HONOR SOCIETY MEMBERSHIP APPLICATION

WVEIS No. ______________________ Grade ________ GPA _________

Leadership Roles- List all elected or appointed leadership positions or other positions of responsibility held in school, community, or work activities. Only positions in which you were responsible for directing or motivating others should be included (ex: elected officer, team captain, leader, manager, chairperson). Leadership Role Grad e Activity/Organization Supervising Adult

Service Activities-List community service and club activities in which you have participated. This can be done in or out of school but must be done for or on behalf of others (do not include work done for family members or anything which you were paid). List activities outside of school such as Boy or Girl Scouts, religious groups, etc. Activity Grad e Hours of Service Supervising Adult

School Activities & Involvement- List all school-based activities (not listed above) in which you have participated in school. List all awards or honors received. Activity Grad e Accomplishments/Awards/Honors

Essay- Use the back of this form to write why YOU should be selected and write any other information that you feel we should know.

CAPITAL HIGH SCHOOL NATIONAL HONOR SOCIETY MEMBERSHIP APPLICATION

Name ___________________________________ 2 WVEIS No. ____________________ Grade ______ Page

Signatures Please read and sign below. I understand that completing and submitting an application form does not guarantee selection to the Honor Society, I attest that the information presented here is complete and accurate. If selected, I agree to abide by the standards and guidelines of the chapter and to fulfill all of my membership obligations to the best of my ability. Student Signature: _____________________________________ Date: __________ I/we have reviewed the full Candidate Information Packet provided to us by the Capital High School NHS Chapter. In addition, I/we have read the information submitted by my son/daughter on this form and can verify that it is true, accurate, and complete. Parent Name: _________________________________________ Parent Signature: ______________________________________ Date: __________ Contact Information (we request this information so that we can send you information after the selections). Address: ____________________________________ City _____________________ State: _______________________________________ Zip Code ________________ Capital High School Administration SignaturesPrincipal: ________________________________________ Vice Principal: ____________________________________ Vice Principal: ____________________________________ Vice Principal: ____________________________________