National Honors Society Application 2019-2020

Please fill this form out by October 29, 2019.
Please turn in your transcript to Mirjana or Tran by October 29, 2019 or email it to
Please turn in the club fee to Jason or Tran by November 14, 2019. If late, you MAY be charged a $2 late fee.
If you do not pay the fee, your application MAY be voided.
However, if the fee is an issue for you, please let Tran or Mr. Mapplebeck know ASAP.
Last Name *
First Name *
Email *
Student ID # (If you don't know, type N/A) *
Grade Level *
Leadership Positions
List all elected or appointed leadership positions held in school, community, or work activities. Only those positions in which you were responsible for directing or motivating others should be included. Examples: elected officer for the student body, class, or club; committee chairperson; team captain; newspaper editor; work area manager; or another community leader. Please include the name of the adult responsible for supervising your leadership in each position.
List your Leadership Positions (if non-applicable, type N/A) *
Service Activities
List service activities in which you have participated. These can be individual or group service projects done either in or out of school. Generally speaking, service activities are those that are done for or on behalf of others (not including immediate family members) for which no compensation (monetary or other) has been given. Please ask an adult supervisor who can verify your participation in each activity to sign on the appropriate line, and also list the estimated number of hours you invested while performing this service.
List your Service activities (if non-applicable, type N/A) *
Other Student Activities
List all other school-based activities (not noted above) in which you have participated in school.
Include clubs, teams, musical groups, etc., and any significant accomplishments in each.
List your Other Student Activities (if non-applicable, type N/A) *
Other Community Activities
List other community activities in which you have participated and note any major accomplishment in each. These should be any activities outside of school in which you participated for the betterment of your community. For example: religious groups, clubs sponsored outside the school, Boy or Girl Scouts, community art endeavors, etc. Do not repeat participation already listed above. Please include the name of the adult supervisor of each activity.

List your Other Community Activities (if non-applicable, type N/A) *
Work Experience, Recognition, and Awards
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 Honor Society. Work experience may be paid or volunteer.
List your Work Experience, Recognition, and Awards (if non-applicable, type N/A) *
Electronic Signature
By inputting my First Name and Last Name below,

I understand that completing 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.
Signature *
Questions or Comments or Suggestions
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