Name (print)__________________________________________________

National Honor Society

Application for Membership

William Tennent High School

2017-2018

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Congratulations, you have been nominated to apply for William Tennent’s High School’s chapter

of the National Honor Society. Only students with a cumulative non-weighted GPA of 3.5 or above

may apply. If you are interested in becoming a member, please fill out the attached application.

The following checklist may be of assistance to you to ensure a complete application.

_____________1.) Student Information

_____________2.) Student and Guardian Signatures

_____________3.) Leadership Document with Signatures

_____________4.) Service Activities with Adviser Validation

_____________5.) Two Completed Evaluations with Adviser Validation

_____________6.) Completed Essay

Selection Process:

Selection to NHS is a privilege and an honor, not a right. Students do not apply for

membership in the National Honor society; instead, they provide information to be

used by the selection committee to support their candidacy for membership.

Membership is granted only to those students selected by the Faculty Council.

Membership is not automatically conveyed simply because a student has achieved a

specified level of academic performance. William Tennent’s local chapter of the

NHS emphasizes the components of leadership, service, and character in the

selection process.

By completing this application, you have acknowledged that you accept the process

of selection by the Faculty Council and understand that selection is final.

Deadline: This application must be completed and returned to Mrs. K-B by Friday, September

22, 2017 by 2:30 p.m. Applications not received or fully completed by this date will

not be considered. Acceptance and denial letters will be given out on October

13th. If accepted, our NHS Induction ceremony will be on October 26th at 7:00

p.m.

Signature: Upon completion, please finalize this application by signing below.

Applicant: ____________________________________________________Date_______________

Parent/Guardian: _______________________________________________Date_______________

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*STUDENT INFORMATION:

Name___________________________________________________________________________ Last First Middle

Grade (2017-2018) ____________ 1st Period Classroom Teacher:__________________

Address_________________________________________________________________________ Street City State Zip code

Phone Number_______________________________________

E-Mail Address (Please Write Very Clearly)__________________________________________

To be completed by your grade level disciplinarian

List any discipline referrals this student has received since freshman year. Please be sure to include

a brief description of the issue(s).

(PLEASE HAND THIS FORM TO THE YOUR HOUSE SECRETARY FOR

YOUR GRADE LEVEL DISCIPLINARIAN TO COMPLETE)

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Leadership:

The leadership criterion is considered highly important for membership selection. Some

Faculty Councils may wish to interpret leadership in terms of the number of offices held in school

or community organizations. It is important to recognize that leadership also exists outside elected

positions including effective participation in other co curricular activities offered on campus. Other

Faculty Councils may define leadership in less objective terms. Leadership roles in both the school

and community may be considered, provided they can be verified.

The student who exercises leadership:

Is resourceful in proposing new problems, applying principles, and making suggestions

Demonstrates initiative in promoting school activities

Exercises positive influence on peers in upholding school ideals

Contributes ideas that improve the civic life of the school

Is able to delegate responsibilities

Exemplifies positive attitudes

Inspires positive behavior in others

Demonstrates academic initiative

Successfully holds school offices or positions of responsibility; conducts business

effectively and efficiently; demonstrates reliability and dependability

Is a leader in the classroom, at work, and in other school or community activities

Is thoroughly dependable in any responsibility accepted

Is willing to uphold scholarship and maintain a loyal school attitude.

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*Student Completes

Name (print)__________________________________________________

Leadership Positions: List all your elected or appointed leadership positions held in school,

community, or work activities. Please include only those positions in which you were directly

responsible for motivating others. For example, elected student class, or club officer, team captain,

newspaper editor; or work area manager are all positions that satisfy these criteria. Please to

include a letter of recommendation from someone outside the school who may be familiar with your

leadership positions.

Activity

Leadership

Position

Grade

9

Grade

10

Grade

11

Grade

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Sponsor Signature

EXPAND: Feel free to expand on any or all of the leadership positions listed above.

On the next page, we provide a basic form for you to complete and share. Make copies as needed

and provide your sponsor(s) with envelope(s). Forms must be placed individually in a sealed

envelope, with the sponsor’s signature on the seal or directly e-mailed to Mrs. K-B by September 20

in order for you to hand them in by Sept. 22.

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WILLIAM TENNENT NATIONAL HONOR SOCIETY

LEADERSHIP EVALUATION FORM

*TO BE COMPLETED BY APPLICANT:

Name of student: ________________________________________

Leadership Activity: _________________________________________________

Length of Time in Activity (only count since entering 9th grade): ____________________

*FOR THE ADULT SUPERVISOR:

We are considering a member of your activity for induction into the National Honor Society. For the

purpose of examining his/her leadership role, the student should have requested from you a letter

confirming the position. Ideally, this letter should be on company letterhead, and include the leadership

position. Please specify years and dates and do not share it with the applicant.

Please do not include the applicant’s name within the letter itself. Please put

his/her name outside the sealed envelope and/or on the back side of the letter. If

you e-mail this to me, please see my e-mail address below.

For clarification, leadership is considered when a student is responsible for directing and/or teaching

others. Examples include, but are not limited to, tutoring in academic subjects, acting as a camp counselor,

captain of a sports team, athletic coach, work manager or trainer, religious instruction teacher, orchestra

section leader, or a newspaper editor, etc.

Please attach the letter to this form and place it in a sealed envelope without sharing it with the student.

Sign over the seal and return to the student or send it to me BEFORE OR ON September 22. Thank you

for your time.

Mrs. King-Berkovitz

NHS Adviser kingna@cenntennialsd.org

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Service:

Service is generally considered to be those actions taken by the student which are done with

or on behalf of others without any direct financial or material compensation to the individual

performing the service. In considering service, the contributions this candidate has made to school,

classmates, and community, as well as the student’s attitude toward service can be reviewed.

The student who serves:

Volunteers and provides dependable and well organized assistance, is gladly

available, and is willing to sacrifice to offer assistance

Works well with others and is willing to take on difficult or inconspicuous

responsibilities

Cheerfully and enthusiastically renders any requested service to the school

Is willing to represent the class or school in inter-class and inter-scholastic

competition

Does committee and staff work without complaint

Participates in some activity outside of school- for example: Girl Scouts, Boy

Scouts, church groups, volunteer services for the elderly, poor, or disadvantaged

Mentors persons in the community or students at other schools

Shows courtesy by assisting visitors, teachers, and students.

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*SERVICE ACTIVITIES

Please list all the service activities in which you have participated through the course of the

past and current school year. If you received any payment, you cannot count the work as

service.

Guidelines:

1. Students must complete 4 hours of community service from Jan. 15, 2017, to when the

application is submitted.

2. At minimum, the evidence of leadership service should be equivalent to ½ hour weekly for

a minimum of one marking period.

3. Leadership events may overlap with Community service events.

Examples:

1.) In school or School related

Clubs/Organizations in school that involve service (not just membership)

2.) Out of School

Clubs/Organizations such as Boy/Girl Scouts, Church groups, Serving the elderly,

children or the disabled, ASPCA, etc.

3.) Interscholastic competition/Sports

Sports Teams, Debate, Mock Trials, Marching Band, Chorale, etc.

________________________________________________________________________________

SERVICE ACTIVITY SPONSOR SIGNATURE

***PLEASE NOTE: This form will be accepted only with advisor’s signature***

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Character:

National Honor Society is a member of the Character Counts! Coalition. Through this

activity, the society supports and recommends the use of a multi-faceted definition of character

known as the “Six Pillars of Character.” A person of character demonstrates the following six

qualities: respect, responsibility, trustworthiness, fairness, caring, and citizenship. Schools are

encouraged to take this model, modify it to meet their local needs, and utilize it frequently in the

work of their chapter.

In addition, it can also be said that the student of character:

Takes criticism willingly and accepts recommendations graciously

Consistently exemplifies desirable qualities of behavior (cheerfulness,

friendliness, poise, stability)

Upholds principles of morality and ethics

Cooperates by complying with school regulations concerning property,

programs, office, halls, etc.

Demonstrates the highest standards of honesty and reliability

Regularly shows courtesy, concern, and respect for others

Observes instructions and rules, is punctual, and faithful both inside and outside

the classroom

Has powers of concentration, self-discipline, and sustained attention as shown by

perseverance and application to studies

Manifests truthfulness in acknowledging obedience to rules, avoiding cheating in

written work, and showing unwillingness to profit by the mistakes of others

Actively helps rid the school of bad influences or environment.

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National Honor Society – Evaluation of Character It is the applicants responsibility to ensure that each character evaluation is handed in to Mrs. K-B in a sealed

envelope or sent directly to her via e-mail on time. Please feel free to stop by her room to check.

____________________________________ (name) is in the process of applying for induction to

the National Honor Society. Please complete this survey to give NHS a reflection of

CHARACTER for the applicant. Thank you for your cooperation.

Would you describe this person as:

Very Strong Strong Average Below Average Minimal

A good listener 5 4 3 2 1

Reflective 5 4 3 2 1

Dependable 5 4 3 2 1

Even-tempered 5 4 3 2 1

Confident 5 4 3 2 1

Supportive 5 4 3 2 1

Understanding 5 4 3 2 1

Open-minded 5 4 3 2 1

Independent thinker 5 4 3 2 1

Energetic 5 4 3 2 1

Fair-minded 5 4 3 2 1

Caring/Kind 5 4 3 2 1

Compassionate 5 4 3 2 1

Appreciative 5 4 3 2 1

Courteous 5 4 3 2 1

Adaptable/Flexible 5 4 3 2 1

Encouraging 5 4 3 2 1

Respectful 5 4 3 2 1

Patient 5 4 3 2 1

(over)

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Very Strong Strong Average Below Average Minimal

Considerate 5 4 3 2 1

Goal-oriented 5 4 3 2 1

Trustworthy 5 4 3 2 1

Additional Comments:

The person completing this character evaluation can be inside or outside of school (faith members,

social group coordinators, employers, etc.) However, NO FAMILY MEMBERS may complete

this.

Please return this survey to Nancy King-Berkovitz via school e-mail (kingna@centennialsd.org) or

333 Centennial Road, Warminster, PA 18974 postmarked no later than Thursday, September 21,

2017. Any surveys received after Friday, September 22, 2017, and not postmarked by September

21, 2017, cannot be accepted.

Name (print)_______________________________________Title___________________________

Signature______________________________________________ Date______________________

Relationship to student_____________________________________________________________

Number of years you have known this student___________________________________________

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National Honor Society – Evaluation of Character It is the applicant’s responsibility to ensure that each character evaluation is handed in to Mrs. K-B in a sealed

envelope or sent directly to her vis e-mail on time. Please feel free to stop by her room to check.

____________________________________ (name) is in the process of applying for induction to

the National Honor Society. Please complete this survey to give NHS a reflection of

CHARACTER for the applicant. Thank you for your cooperation.

Would you describe this person as:

Very Strong Strong Average Below Average Minimal

A good listener 5 4 3 2 1

Reflective 5 4 3 2 1

Dependable 5 4 3 2 1

Even-tempered 5 4 3 2 1

Confident 5 4 3 2 1

Supportive 5 4 3 2 1

Understanding 5 4 3 2 1

Open-minded 5 4 3 2 1

Independent thinker 5 4 3 2 1

Energetic 5 4 3 2 1

Fair-minded 5 4 3 2 1

Caring/Kind 5 4 3 2 1

Compassionate 5 4 3 2 1

Appreciative 5 4 3 2 1

Courteous 5 4 3 2 1

Adaptable/Flexible 5 4 3 2 1

Encouraging 5 4 3 2 1

Respectful 5 4 3 2 1

Patient 5 4 3 2 1

(over)

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Very Strong Strong Average Below Average Minimal

Considerate 5 4 3 2 1

Goal-oriented 5 4 3 2 1

Trustworthy 5 4 3 2 1

Additional Comments:

The person completing this character evaluation can be inside or outside of school (church

members, social group coordinators, employers, etc.) However, NO FAMILY MEMBERS may

complete this

Please return this survey to Nancy King-Berkovitz via school mail (kingna@centennialsd.org) or

333 Centennial Road, Warminster, PA 18974 postmarked no later than Thursday, September 21,

2017. Any surveys received after received after Friday, September 22, 2017, and not postmarked

by September 21, 2017, cannot be accepted.

Name (print)_______________________________________Title___________________________

Signature______________________________________________ Date______________________

Relationship to student_____________________________________________________________

Number of years you have known this student___________________________________________

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ESSAY

Discuss the essay topic. The essay should be between two hundred and two

hundred and fifty words and must be typed. If it is not typed, it will not be

accepted. Please be attentive to spelling and grammar.

Leadership:

Discuss what leadership means to you.

Explain, in your words, an important attribute of a strong leader.

Discuss how your leadership roles that you have listed in this application will

benefit the Centennial School District community.