National Junior Honor Society s1

National Junior Honor Society Character, Scholarship, Leadership, Service, Citizenship

STUDENT ACTIVITY and INFORMATION FORMS

Directions: Please complete all eight sections. Any incomplete forms will NOT be considered for membership. Do not be modest! The faculty council, who assist with the selection process, will use any and all relevant information. Completion of this form DOES NOT guarantee selection. Remember that membership in NJHS is a privilege, not a right! All materials MUST be turned in by the due date even if you are absent.

I. Administrative Information: (Please print using black ink)

Name Home Address (Include zip code) Phone Number Grade Homeroom Teacher First period Teacher Room

Name of parents/guardians: (Include first, last names and address if different from your home address)

I understand that completing this form does not guarantee selection to National Junior 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 ALL COMPLETED MATERIALS TO: Mr. Dave Pesicka On or before Friday October 6, 2017 by 2:34 p.m. II. School Activities:

Please list all school-based activities in which you have participated. Include significant accomplishments in each. An advisor’s signature is required for each organization marked. Please note: There are Two pages of activities.

Advisor’s Organization 6th 7th 8th 9th Significant Accomplishment grade grade grade grade Signature Academic Challenge Art Club Boys in the Middle Band Baseball Basketball Bowling Chamber Strings Cheerleading Chess Choir Contraption Fair Cross Country Diving & Swimming FCA Flag Corps Football Geography Bee Golf Gymnastics Indoor Track Leadership Conference Advisor’s Organization 6th 7th 8th 9th Significant Accomplishment grade grade grade grade Signature

Marching Band Model UN Morning Announcements Office Assistant Orchestra Power of the Pen Prom Promise Rubies Scarlet Angels School Newspaper School Play Science Olympiad Ski Club Soccer Softball Spanish Club Spelling Bee Sports Trainer Statistician Student Council Track Volleyball Wrestling Yearbook III. Leadership Positions:

List all elected or appointed leadership positions held in school, community, or work activities. Only include those positions in which you were actively responsible for directing or motivating others. For example, include elected student body, class, or club officer; committee chairperson; team captain; work area manager, or community leader.

Leadership 6th 7th 8th 9th Adult Sponsor Position grade grade grade grade Activity/Organization Signature

IV. Community Activities:

List community activities in which you have participated and note a major accomplishment for each one. These should be any activities outside of school in which you participated for the betterment of the community. For example, include church groups, clubs sponsored outside of the school, Boy or Girl Scouts, volunteer groups or community art endeavors. (PSR classes do not constitute a community activity so they should not be listed)

Community Year Year Year Year Major Accomplishment Activity 6 7 8 9 V. Work Experience, Recognition and Awards:

List below any job experiences, honors or recognitions that you have received which support your bid to be selected for membership in the National Junior Honor Society. Work experience may be paid or volunteer.

6th 7th 8th 9th Job or Work Experience grade grade grade grade Paid Volunteer

Attention Applicants: Do Not list REACH or Honor and/or Merit Rolls as “awards.” They have already been considered for you because you already have at least a 3.0 GPA.

6th 7th 8th 9th Recognition or Award grade grade grade grade Group or Activity VI. FACULTY SURVEY FORMS:

Please distribute the faculty survey forms. Eligible teachers include current instructors and instructors from the previous three years. You MUST include as one of your selections a coach or club advisor with whom you are working. Selections may NOT include administrators or guidance counselors. (Faculty will return completed forms directly to the NJHS adviser, Mr. Pesicka by Friday, October 6, 2017.)

IMPORTANT: Be sure to write your name in the student name blank for each faculty survey form.

On the lines below please indicate the names of the three faculty members and coaches/advisors that you have selected to complete the faculty survey form:

1. 2. 3.

VII. ESSAY:

The essay must be 250-300 words in length. Your typed, double-spaced essay should be thoughtful, well-planned, and written for a formal, discerning audience.

Essay prompt for fall 2017:

The ideal candidate for selection to the National Junior Honor Society possesses the qualities of character, scholarship, leadership, service and citizenship. Using these qualities as a guide, discuss only ONE of these qualities in detail. Give specific examples of how you characterize this particular quality and why you should be considered for selection to this prestigious organization.

VIII. LETTER OF RECOMMENDATION:

Have someone from outside of the school who you are currently working with (advisor, coach, instructor, or leader) from an activity in which you have been actively involved write you a letter of recommendation. The person writing this letter must include his/her name, name of activity, position/role, and telephone number. The letter should be mailed directly to the school: Cuyahoga Heights Middle School, Mr. Dave Pesicka, 4820 East 71 st Street, Cuyahoga Heights, Ohio, 44125. You should give the writer a pre-addressed, stamped envelope. Be sure to tell the writer that the deadline for all letters is Friday, October 6, 2016. National Junior Honor Society

Faculty Survey Form for Eligible Students Please return this completed form directly to NJHS Adviser, Mr. Dave Pesicka by Friday, October 6, 2017. Thank you!

NOTE: The information on this form is confidential and will be used to assist the Faculty Council in obtaining an overall impression of each eligible student. All forms will be destroyed after selection. Student’s Name Years acquainted with Student Teacher’s Signature (Mandatory) Date Circle the appropriate letter. Use these descriptions as a guide: (H) HIGH—Consistently or Always (A) AVERAGE—Usually (L) LOW—Rarely or Never SCHOLARSHIP The student has met the minimum grade point average of at least 3.0.

LEADERSHIP The student . . . (H) (A) (L) demonstrates leadership in the classroom or in other school activities. (H) (A) (L) is thoroughly dependable in any responsibility accepted. (H) (A) (L) exemplifies positive attitudes and inspires positive behavior.

SERVICE The student . . . (H) (A) (L) volunteers dependable and well-organized assistance, is gladly available and is willing to sacrifice to offer assistance. (H) (A) (L) works well with others and is willing to take on difficult or inconspicuous responsibilities. (H) (A) (L) cheerfully and enthusiastically renders any requested service to the school.

CHARACTER The student . . . (H) (A) (L) takes criticism willingly and accepts recommendations graciously. (H) (A) (L) exemplifies desirable qualities of personality. (H) (A) (L) demonstrates the highest standards of honesty, reliability, courtesy, concern and respect for others.

CITIZENSHIP The student . . . (H) (A) (L) shows positive interest in the activities of the school. (H) (A) (L) shows a desire to promote harmony among the school population. (H) (A) (L) shows positive attitude toward assisting others in school. Comments: ______National Junior Honor Society

CITIZENSHIP The student . . . (H) (A) (L) shows positive interest in the activities of the school. (H) (A) (L) shows a desire to promote harmony among the school population. (H) (A) (L) shows positive attitude toward assisting others in school.

Comments: ______