LRHS National Honor Society Application

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Please complete all sections. You may print this form and fill it by hand as well. You must submit it by the published deadline. No Late Applications will be accepted. Do not be modest. Every piece of information will assist the Faculty Council with the fair consideration of your candidacy during the selection process. Completion and submission of this form does not guarantee selection. If you should have questions about this form, please contact Mrs. Raybe at jraybe@ghsd.k12.ca.us.

Administrative Information: *

Name - Current Grade Level - 4th per. teacher -

Leadership Positions

What leadership positions have you held? List all elected or appointed leadership positions or other positions of responsibility held in school, community, or work activities. Only those positions in which you were responsible for directing or motivating others should be included. Please include the name of the adult responsible for supervising your leadership position.

Place information for each of your high school years. *

Place your information in this format: Grade 9-Leadership Position Held-Activity/organization-Supervising Adult's Name

List SERVICE ACTIVITIES in which you have participated. These can be individual or group service projects. *

Place your response in the following format: Activity-hours of service-supervising adult

Other Student Acitivities

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.

Place information for each of your high school years. *

Place information in this format: Grade Level-Activity-Accomplishments

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. (e.g., religious groups, clubs sponsored outside of school, Boy or Girl Scouts, community art endeavors, etc.,) Do not repeat information already given in other sections of this form.

Please list your responses in the following format: Grade Level-Total Hours Served-Accomplishments-Supervising Adults Name *

Work Experience/Recognition/Awards

Though not a specific criterion for membership, please list below any jobs experiences, honors or recognition that you have received that support your candidacy for membership in the honor society here at LRHS. Work experience can be paid or volunteer.

Please list your responses in the following format: Grade Level-Job, Recognition or Award-Group or Activity-Hours Spent-Supervising Adult *

Signatures

I understand by filling in my name and address and submitting this form it does not guarantee selection to the LRHS 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.

Please type in your name and home address as your signature, followed by the date you are submitting this application. *

Parent Signature *

I understand by filling in my name and address that I have read the information provided by my son/daughter on this form and can verify that it is true, accurate and complete. Please include your PHONE NUMBER.

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