RIVER RIDGE HIGH SCHOOL NATIONAL HONOR SOCIETY Candidate’s Data Form

Date Due: March 20, 2017

Please print your name as you would like it printed on your certificate.

Name (Last) (First) (Middle)

Name of Parents or Guardian:

Phone:

Address:

Birth Date:

Schools Attended (9-12):

School Activities. List all clubs, teams, services, honors, etc. in which you have been involved. If you provided leadership, please be sure to indicate this.

Freshman Year Sophomore Year Junior Year Senior Year Community Activities: List 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. For example: church groups, clubs sponsored outside the school, Boy or Girl Scouts, volunteer groups, or community art endeavors.

Freshman Year Sophomore Year Junior Year Senior Year

Work Experience, Recognition, and Awards: List any job experiences, honors, or recognitions that you have received which support your bid to be selected for membership in the National Honor Society. Work experience may be paid or volunteer. Please indicate the number of hours spent on job or volunteer activity. Freshman Year Sophomore Year Junior Year Senior Year

Describe your responsibilities at home: List the classes you have taken and the final grade earned in each as well as those classes you are currently taking.

Semester Freshman 1 2

Semester Sophomore 1 2 Semester Junior 1 2

Semester Senior 1 2

In the space below, handwrite or type a paragraph which tells one of the following:

a. Why you wish to be selected as a member. b. Why you feel you should be selected. c. What makes you a special person? I understand that in accepting membership I agree to participate in the organization’s projects (service, money-making and special projects).

I understand that completion of this form does not guarantee membership in the National Honor Society, but it does mean that I am being considered for membership. I accept as final the decision of the faculty committee charged with the responsibility of selecting members. I also grant permission for public release of the results of selection, should I be selected.

(Signature of Applicant) (Date)

As legal guardian of the above applicant, I have read the above and the selection procedure and concur with it.

(Signature of Parent(s) or Guardian(s) ) (Date)