WEST DELAWARE NATIONAL HONOR SOCIETY STUDENT ACTIVITY INFORMATION FORM

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DELAWARE ANNUAL CFSR PROGRAM IMPROVEMENT PLAN REVIEW NOVEMBER

West Delaware

West Delaware

National Honor Society

Student Activity Information Form

Directions: Please complete all sections. Please download and type all information and submit it by 3:30 p.m. on Friday, October 4, 2019 to Mrs. Hermsen, NHS Advisor. This completed form should be emailed to Mrs. Hermsen at: [email protected]. A hard paper copy with student and parent signatures, and letters of recommendation(s) should be given to Mrs. Hermsen at school, room 234. The information you provide in this form will be used by the faculty council to assist with the fair consideration of your candidacy during the selection process. Please read the criteria for selection located at the end of this document to help guide you in filling out the information.

Completion and submission of this form does not guarantee selection. If you have any questions about this form, please contact Mrs. Hermsen, NHS Advisor.

ADMINISTRATIVE INFORMATION

Name____________________________________________ Grade__________________

Before completing Student Activity Information Form, please read the Criteria for Selection and the NHS Selection Process information attached at the end of this form.

LETTER OF RECOMMENDATION – CHARACTER REFERENCE:

Along with the student activity information, please include at least one letter (but not more than three) of recommendation as a character reference. This reference cannot be from a relative or any West Delaware staff member. All letters of recommendation must be turned in with the information form to Mrs. Hermsen by the application deadline.

SIGNATURES:

I understand that completing and submitting this form does not guarantee selection to the West Delaware Chapter of the National 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 the membership obligations to the best of my ability.

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.

Parent Signature____________________________________________ Date_________________

Return completed form and a letter(s) of recommendation to

Mrs. Hermsen, NHS Adviser in room 234 at the high school

by Friday, October 4, 2019 by 3:30 p.m.

LEADERSHIP POSITIONS:

List all elected or appointed leadership positions or other positions of responsibility held in school, community, or work activities that you have been active in during high school. Only those positions in which you were responsible for directing or motivating others should be included (ex. Student Council Officer, Class Officer, committee chairperson, team captain, newspaper editor, manager, etc.) Please include the name and phone number of the adult responsible for supervising your leadership in each position.

Grade (Year)	Leadership Position	Activity/Organization	Supervising Adult	Phone Number

SERVICE ACTIVITIES:

List service activities in which you have participated since you have been in high school. These can be individual or group service projects done either in or out of school. Generally, service activities are those that are done for or on behalf of others (not including immediate family members) for which no compensation (monetary or otherwise) has been given. Please list an adult supervisor and their phone number, who may be called to verify your participation in each activity. Also list the estimated number of hours you invested while performing this service. A minimum of 10 service hours is required to be considered for selection in the National Honor Society.

Grade (Year)	Activity	Hours of Service	Supervising Adult	Phone Number

OTHER STUDENT ACTIVITIES:

List all other school based (not listed above) activities in which you have participated in school. Include clubs, teams, musical groups, etc., and any significant accomplishments in each.

Grade (Year)	Activity	Accomplishments

OTHER COMMUNITY ACTIVITIES:

List other community activities in which you have participated and note any major accomplishments in each. These should be any activities outside of school in which you participated for the betterment of your community (ex. religious groups, clubs – such as 4-H or Boy/Girl Scouts, etc.) Do not repeat participation already listed above. Please include the name of the adult supervisor of each activity. Only include activities you have been involved in during high school.

Grade (Year)	Community Activity	Hours	Accomplishments	Supervising Adult	Phone Number

WORK EXPERIENCE:

Though not a specific criterion for membership, please list below any job experiences, honors, or recognition that you have received that support your candidacy for membership in the National Honor Society. Work experience may be paid or volunteer.

Grade (Year)	Job, Recognition, or Award	Group or Activity	Hours worked	Supervising Adult	Phone Number

REFLECTION ON SERVICE ACTIVITY: From your list of service activities, please elaborate on one service activity you have been involved in and what impact it had on you or others?

2019-2020

WEST DELAWARE

NATIONAL HONOR SOCIETY

CRITERIA FOR SELECTION

The Faculty Council of the chapter selects students who demonstrate outstanding performance in all four criteria:

Scholarship
Leadership
Service
Character

SCHOLARSHIP

Membership is based on student’s cumulative grade point average of 3.5 or higher at the end of their sophomore year. If GPA falls below 3.5 at any time, membership may be revisited.

LEADERSHIP

Members can participate in extracurricular activities OR community leadership roles in order to fulfill this requirement. The student who demonstrates leadership: (As stated in the National NHS Handbook)

Is resourceful in proposing new problems, applying principles, and making suggestions
Demonstrates initiative in promoting school activities
positive influence on peers in upholding school ideals and spirit
Contributes ideas that improve the civic life of the school
Is able to delegate responsibilities
Exemplifies positive attitudes
Inspires positive behavior in others
Demonstrates academic initiative
Successfully holds school offices or positions of responsibility
Conducts business efficiently and effectively
Demonstrates reliability and dependability
Is a leader in the classroom, at work, or in school or community activities
Is dependable in any responsibility accepted

SERVICE

Service is considered as any actions taken in the school or community by the student on behalf of others without direct financial or material compensation to that individual. The student who demonstrates service: (As stated in the National NHS Handbook)

Volunteers and provides dependable and well-organized assistance, is gladly available, and is willing to sacrifice to offer assistance
Works well with others and is willing to take on difficult or inconspicuous responsibilities
Cheerfully and enthusiastically renders any requested service to the school
Is willing to represent the class or school in interclass and interscholastic competition
Does committee and staff work without complaint
Participates in some activity outside of school (examples: Boy or Girl Scouts, 4H, religious groups, volunteer organizations, etc.)
Mentors person in the community or students at other schools
Shows courtesy by assisting visitors, teachers, and students

CHARACTER

A person of character demonstrates six qualities: responsibility, trustworthiness,

respect, fairness, caring, and citizenship. The student who demonstrates character:

(As stated by the National NHS Handbook)

Takes criticism willingly and accepts recommendations
Consistently exemplifies desirable qualities of behavior (cheerful, friendly, poised, etc.)
Cooperates by complying with school regulations concerning property, programs, office, halls, etc.
Demonstrates the highest standards of honesty and reliability
Regularly shows courtesy, concern, and respect for others
Observes instructions and rules, is punctual, and faithful both inside and outside the classroom
Manifest truthfulness in acknowledging obedience to rules, avoiding cheating in written work, and showing an unwillingness to profit by the mistakes of others
Actively helps rid the school of bad influences or environment

NHS SELECTION PROCESS

Juniors and seniors at West Delaware with a grade point average of 3.5 are eligible to apply for membership. Mrs. Hermsen, NHS Advisor will contact all students that are eligible to apply. These students will receive information by mail on how to apply along with the deadline for applications. Along with scholarship, the other selection criteria include: leadership, character and service. Applicants are required to submit a National Honor Information Form and a letter of recommendation in order to be considered for membership.

After the information forms have been submitted, the names of the applicants are shared with the entire faculty who are encouraged to give their input to the Faculty Council. The entire faculty will only give an evaluation on those individuals who they know because they have taught, coached, or supervised them. The faculty evaluation is a method used to support the applicant’s candidacy based on their service, leadership and character.

The Faculty Council is then assigned with the task of reading the information submitted by each applicant, reviewing faculty evaluations, and making the final selection decisions. The Faculty Council is made up of five faculty members and one alternate member. Admission to the National Honor Society requires a majority vote of the Faculty Council. The NHS Advisor is an ex-officio, non-voting member of the committee.

APPLICATION DEADLINE:

Friday, October 4, 2019 at 3:30 p.m.

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