Higgins Middle School Chapter of the National Junior Honor ...



Higgins Middle School Chapter of the National Junior Honor Society

[pic]

Student Activity Information Form

Directions: Please complete all sections and attach any community service letters you may have. Please print all information clearly and submit by December 23, 2014. All of the information will be reviewed by the Faculty Council to assist with the consideration of your candidacy during the selection process.

Completion and submission of this form does not guarantee selection. Should you have any questions about this form please contact Mr. Powers in room #72.

I. Administrative Information

Name Cluster Homeroom

II. Student Activities- List all school and non-school based activities in which you have participated in since 6th grade. Include clubs, teams, musical groups, religious groups, Boy or Girl Scouts, etc. Please include the name of the adult supervisor of each activity and your leadership role if applicable.

|Date |Activity |Name of Supervising Adult |Leadership Role (if applicable) |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

III. Essay Component- Please respond to the following question on a separate sheet of paper. Your response must be type-written, size 12 Times New Roman font, and contain between 300-400 words.

What differentiates you from your peers? Which qualities do you possess that make you stand out as a potential National Junior Honor Society member?

IV. Signatures- I understand that completing and submitting this 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 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 this form to Mr. Powers in room #72 by December 23, 2014. No forms will be accepted late.

If you have any questions please email me at PowersB@Peabody.K12.MA.US

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download