W. B. Yeats Chapter of the National English Honor Society
MEMBERSHIP APPLICATION
APPLICANT INFORMATION
Full Name *
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Student ID *
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Date *
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Address *
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City, State, Zip *
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Telephone *
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Cell phone (if different) *
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Email *
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SCHOOL INFORMATION
Date Enrolled *
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Expected Graduation *
Month/Year
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English GPA *
Ask your guidance counselor
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High School Honors Courses Taken *
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Dual Enrollment or AP Classes Taken *
English courses only
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EXTRA-CURRICULAR ACTIVITIES
Membership in Other Honor Societies *
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Membership in Service Clubs *
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Membership in Sports Teams *
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ENGLISH CLASSES
English Classes Taken *
Indicate level AND grade earned
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English-related Classes Taken (i.e. Drama, Mass Comm, Speech, or Journalism) *
Indicate level AND grade earned
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English-related Activities (i.e. articles or poems published, speeches given, etc.) *
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MISCELLANEOUS
Have you ever been referred to a principal for serious misconduct or academic dishonesty? *
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If Yes, please explain: *
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Writing Sample (Optional)
Paste a piece of writing no longer than 500 words: an essay, a fiction sample, a poem, dramatic scene, etc.
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Statement: To the best of my knowledge, the above information is true and correct. False or misleading information will result in cancelled membership. *
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Signature *
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