NHS Application Packet 2012- 2013 Rev 7-30-12

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    Candidate Profile

    Packet

    NATIONAL HONOR SOCIETYJACKSON CHAPTER

    2012 - 2013

    Jackson Memorial High School

    Jackson, New Jersey

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    National Honor SocietyJackson Chapter

    National Honor Society Selection Procedures

    The National Honor Society is sponsored by the National Association ofSecondary School Principals and, as a recognized chapter, it is required to adoptand follow the national constitution. Our chapter has also adopted its ownconstitution which further outlines the procedures of selection.

    1. In August, juniors (based on four semesters) who have a grade pointaverage of 4.0 or better and seniors (based on six semesters) who havea grade point average of 4.0 or better are invited to an orientationsession on the National Honor Society. This orientation introduces

    students to the National Honor Societys purpose, requirements, and theselection process, including the required profile, essay, andrecommendations.

    2. In September, each eligible student must submit completed profiles,essay, and recommendations by the date listed in the application. TheFaculty Council, composed of five teachers and the National HonorSociety advisor, is formed.

    3. In early September, a list of eligible students is distributed to staffmembers for additional input to the Faculty Council. This input must bewritten and is given to the National Honor Society advisor, who sits ex-officio on the council.

    4. In October, the Faculty Council meets to review the candidates. Thisreview involves consideration of each students leadership, service, andcharacter based on the information available to the Faculty Council,including the profile, recommendations, discipline reports, attendancerecords, essay, and faculty input. A majority vote of the Council isrequired for selection.

    5. Selected students are advised by the National Honor Society advisor ina letter in October. Induction is held in November.

    6. Acceptance is an honor and not a right of a student and therefore thedecision of the Faculty Council is final.

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    National Honor SocietyJackson Chapter

    Outline of Procedures in Completing Candidate Profile

    Membership in the National Honor Society is based upon the demonstratedcharacteristics of Scholarship, Service, Leadership, and Character.

    SCHOLARSHIP

    To be eligible for membership, a student must attain a fixed and specific

    grade point average. Academic ranking will be used for the purposes of makingthe determination on grade point average. Ineligible students may request thattheir GPA be reviewed to insure its accuracy. In order to qualify for membershipstatus, one must earn a 4.0 GPA or higher.

    Attaining the grade point average brings students to the first level ofcandidacy. Verifying the academic records allows a student to proceed to the nextlevel. At any point in the selection process, a student may withdraw his/hercandidacy. Students who do not withdraw thereby give their consent to have theircandidacy reviewed in accordance with the established procedures.

    SERVICE, LEADERSHIP, and CHARACTER

    1. To complement their academic accomplishments, candidates mustdemonstrate and document sustained interest, effort, and achievement inextra-curricular activities and volunteer work. Candidates are asked tosubmita list of school and/or community activitiesin which they haveparticipated during high school. Students must request verification to besubmitted from three different advisors/coaches (no more than two sportswhich must be varied) of the listed activities. The activities must includeat least one service or volunteer activity outside of school with

    documentation of 30 hours or more. One of the activities must also be aschool activity. This documentation must attest to the candidates activeparticipation in the activity; it should also verify elements of service,leadership and character within the activity. It is the responsibility of thecandidate to insure that the verification statements are complete andsubmitted in accordance with established timelines. An unsatisfactoryadvisor verification will be reason for non-acceptance into the chapter

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    2. Candidates will also be asked tosubmit recommendations fromthree (3)teachersattesting to their service, leadership, and character. Theselected teachers cannot be one of the advisors or coaches that completed anactivity recommendation for the candidate.

    3. All candidates will be required tocomplete an essay. More specificinformation regarding the required essay can be found in the packet.

    National Honor SocietyJackson Chapter

    HELPFUL HINTS

    In order to increase your chances of acceptance, please read carefully thefollowing list of dos and do nots.

    DO

    *Docomplete all information on the forms neatly and legibly.

    *Dolist a variety of activities (e.g. one sport, two clubs, etc.) One of the activitiesmust be a school activity.

    *Dosubmit your application on time. Failure to submit the completedapplication by Tuesday, September 25, 2012 will constitute automaticdisqualification.

    *Dolist activities in which you have been a member for at least one full year.

    *Douse the appropriate recommendation forms.

    *Do return your completed application directly to Ms. Bunce Room 145.

    *Docomplete the top portion of all forms (Teacher Recommendation and AdvisorVerification).

    *Dogive considerable thought and care in writing the essay.

    *Dotype your essay.

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    *Doprovide community advisors with a stamped envelope addressed to Ms.Bunce.

    *Doverify that the advisor has signed in both places on the Advisor VerificationForm.

    DO NOT

    *Do notlist a paid activity (e.g. baby-sitting, part-time jobs, etc.) as one of yourthree (3) required activities.

    *Do notlist an activity that you have not participated in for a year. (Example: anactivity you have just joined this fall or late last spring).

    *Do notlist middle school activities.

    *Do notlist private volunteer work.

    *Do notask the same teacher to complete two forms (e.g. a TeacherRecommendation and an Advisor Verification.

    *Do notsubmit two (2) Advisor Verification forms for the same activity (e.g. varsitybasketball and CYO basketball).

    *Do notask two advisors/coaches to write a recommendation for the same activity(e.g. head coach and assistant coach).

    *Do notask a friend to submit your completed application. Do not put yourcompleted application in Ms. Bunces mailbox.

    *Do notuse pencil. Use ink or type!

    *Do notwait until the last minute to request recommendations of your teachers/advisors.

    *Do notsubmit the application without beingcompletelyfilled out. Incompleteswill notbe accepted.

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    The following is a list of activities that will not be considered as one of thethree required activites:

    1. Any club or activity which is not academic or service oriented (e.g. chessclub, intramurals, ski club);

    2. Lessons outside of school (e.g. dance, piano) unless you are involved incompetition.3. Religious classes (e.g. CCD, Hebrew school) unless you hold a leadership

    role. Dolist youth group activities.4. Classes (e.g. band, ROTC) unless your involvement goes beyond class

    requirements.5. One day activities (e.g. Teen Arts, Jackson Day, PALS, and Heroes and

    Cool Kids, etc.).NOTE: You may list these activities as part of your student activity profile.

    Acceptable and Unacceptable Activities include:

    Two varied sports such as basketball and soccer will be accepted.However, Winter Track and Spring track do not count as two separateactivities. JMHS Baseball and recreational or traveling baseball do notcount as two separate activities because they are the same sport.

    Acceptable In-School Activities are:o The Key Clubo Interact Clubo Eco-Action Clubo Art Honor Societyo

    Foreign Language Honor Societyo Math Leagueo Dance Teamo Drill Teamo Color Guardo Choruso Cheerleadingo Drama Clubo Future Business Leaders of Americao Stage Crewo Literary Magazineo

    Mock Trialo Pep Clubo Jackson Jaguaro Student Councilo Marching Band/ Stage Band/ Jazz Bando ROTCo Tri M Honor Society

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    GOOD LUCK!

    Remember the completed application is due Tuesday September 25, 2012

    National Honor Society

    Jackson Chapter

    National Honor Society Selection Process Essay

    Membership in the National Honor Society is awarded to those studentswho have become involved and made positive contributions in many different typesof situations. The essay is a significant and reliable source of information aboutyou, the applicant. It is the only part of the application that is still open todevelopment. It is an opportunity to show the Faculty Council a little aboutyourself, your insights, your enthusiasm, and your writing ability. It is also a

    separate part of the application and should convey information not foundelsewhere.

    Take advantage of this opportunity. Consider the essay to be of equalimportance to other parts of your application, such as activities, which consumedmany hours. Outline and organize carefully. Try to write something that is yourbest piece of work. Rewrite it as many times as is necessary to present what youwant to communicate in the best possible way. Remember that this is your ownwork. You are expected to compose and edit your essay without any assistance.

    In order to assist the Faculty Council with the selection process, please

    respond in a well-organized and well-written essay of a minimum of500 wordsand a maximum of two pagesto the topic below. All aspects of the topic must beaddressed.

    Your response must be typed/word processed. Use plain 8 x 11 paperand a formal research paper format according to the JMHS ResearchGuidewhich can be found on the JMHS website. A poorly developed theme, spellingerrors, or problems with language mechanics will not demonstrate the scholarshipexpected of candidates for the National Honor Society. The essay is a significantpart of the selection process and must be recognized as such by all candidates.

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    Homeroom Teacher:

    Homeroom number:

    Grade Level: _______________

    National Honor SocietyJackson Chapter

    Candidate Data Form

    Name_____________________________________________________________

    (Last) (First) (Middle Initial)

    Grade:_______ Counselor:_____________________________

    I have______have not______ failed any course in high school.

    I have______have not______had credit withdrawn because of attendance

    problems in high school.

    I have______have not______been involved in any disciplinary matter while at

    Jackson Memorial High School which resulted in ASD, ISS, or OSS.

    I have ______have not______violated the Academic Integrity Code

    (plagiarism, cheating, counterfeit work, theft, unauthorized reuse of work)

    If have is checked, please explain the situation in which you have been

    involved using the back of the paper if necessary.

    __________________________________________________________________

    __________________________________________________________________

    __________________________________________________________________

    __________________________________________________________________

    Signature_______________________________________

    Date____________________________________________

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    National Honor SocietyJackson Chapter

    Student Activity Report

    Candidatesname:_______________________________________Grade:________________

    Instructions to candidates:

    1. Please list below the activities, both school and community, in which you

    have participated during your school career. Do not list activities you haveintentions of joining this fall. In addition, list any honors or awards which youhave earned during high school and any summer and/or part-time jobs you held.Remember, anyfalsification will be considered an adverse reflection on yourcharacter.

    2. Please have three (3) teachers/advisors complete the Advisor EvaluationChecklist forms included in this packet. Please have your coach, advisor, orteacher submit the evaluation directly to Ms. Bunce, or mail it to Ms. Bunce,Jackson Memorial High School, 101 Don Connor Boulevard, Jackson, New Jersey08527, or fax to (732) 833-4679 no later thanSeptember 25, 2012.

    I. School Activities(Student Council, Clubs, etc.)

    ACTIVITY GRADE

    POSITION TIME ADVISORS NAME &DAYTIME PHONE #

    SIGNATUREOF ADVISOR

    Example:Literary Views 10, 11

    Staff (10)Editor (11)

    1 hr./wk.30 wk./yr.

    Mr. Miller 555-0000

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    II. Sports (Please indicate Freshman, JV, or Varsity)

    SPORT GRADE POSITION TIMECOACHS NAME AND

    DAYTIME PHONE # SIGNATUREOF ADVISORExample:VarsitySoccer

    11, 12 Goalie 10hrs./wk.

    Coach Don Smith 555-0000

    III. Honors/Awards (Honor Roll, athletic awards, etc.)

    HONOR/AWARD DATE RECEIVEDExample:Principals Honor Roll 11/30/03, 3/5/04

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    IV. Employment (Summer, part-time, etc.)

    PLACE OFEMPLOYMENT

    DATE OFEMPLOYMENT

    POSITION TIME EMPLOYERS NAME ANDDAYTIME PHONE #

    IV. Community Activities (Scouts, religious organizations, hospital volunteersetc.)Must be a recognized organization.*

    ACTIVITY DATE OFPARTICIPATION

    POSITION TIME ADVISORS NAME &DAYTIME PHONE #

    SIGNATUREOF ADVISOR

    * private volunteer work does not count

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    National Honor SocietyJackson Chapter

    Student/Parent Acknowledgement

    I understand that completing this form does not guarantee selection to theNational Honor Society, and that the information presented here is accurate.

    _______________________________________________ ________________Student Signature Date

    I have read the information provided by my son/daughter on this application andcan verify that it is true, accurate, and complete in its presentation.

    _______________________________________________ ________________Parent/Guardian Signature Date

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    National Honor SocietyJackson Chapter

    Candidate Checklist

    Before submitting your candidate profile, check that the followingrequirements have been met:

    -Essay completed according to guidelines.

    -Recommendations requested of three (3) teachers.

    -Candidate Data Form completed and signed.

    -Student Activity Report completed.

    -Advisor verifications requested of three (3) advisors/coacheswith signature on front and back of form.

    -Student/Parent Acknowledgement signed and dated.

    -All information submitted according to required timelines--finaldeadline is Tuesday, September 25, 2012.

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    Teacher Recommendation for the National Honor Society

    Student: Please complete your name, name of teacher,and title of course before giving the recommendation to

    the teacher.Name of Candidate_____________________________________________________________

    Name of Teacher Writing Recommendation___________________________Title and level of the course _______________________________________

    Please check the appropriate box (5 is best)

    1 2 3 4 5

    Academic MotivationRespectful

    Academic Self-Discipline

    LeadershipConcern for others

    Responsible/AccountableMaturity

    Personal InitiativeReaction to Setback

    Honesty/Integrity

    TOTAL NUMERIC SCORE: ____________

    Please feel free to write whatever you think is important about the applicant. We

    welcome information that will help us differentiate this student fromothers who seek entrance into the National Honor Society. Please use thereverse side for your additional comments.

    Please do not complete or sign the recommendation unless the student hascompleted the top part of this form.

    Signature_________________________________________Date___________

    Please return to Ms. Bunces mailbox before September 25, 2012

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    Teacher Recommendation for the National Honor Society

    Student: Please complete your name, name of teacher,and title of course before giving the recommendation to

    the teacher.Name of Candidate_____________________________________________________________

    Name of Teacher Writing Recommendation___________________________Title and level of the course _______________________________________

    Please check the appropriate box (5 is best)

    1 2 3 4 5

    Academic MotivationRespectful

    Academic Self-Discipline

    LeadershipConcern for others

    Responsible/AccountableMaturity

    Personal InitiativeReaction to Setback

    Honesty/Integrity

    TOTAL NUMERIC SCORE: ____________

    Please feel free to write whatever you think is important about the applicant. We

    welcome information that will help us differentiate this student fromothers who seek entrance into the National Honor Society. Please use thereverse side for your additional comments.

    Please do not complete or sign the recommendation unless the student hascompleted the top part of this form.

    Signature_________________________________________Date___________

    Please return to Ms. Bunces mailbox before September 25, 2012

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    Teacher Recommendation for the National Honor Society

    Student: Please complete your name, name of teacher,and title of course before giving the recommendation to

    the teacher.Name of Candidate_____________________________________________________________

    Name of Teacher Writing Recommendation___________________________Title and level of the course _______________________________________

    Please check the appropriate box (5 is best)

    1 2 3 4 5

    Academic MotivationRespectful

    Academic Self-Discipline

    LeadershipConcern for others

    Responsible/AccountableMaturity

    Personal InitiativeReaction to Setback

    Honesty/Integrity

    TOTAL NUMERIC SCORE: ____________

    Please feel free to write whatever you think is important about the applicant. We

    welcome information that will help us differentiate this student fromothers who seek entrance into the National Honor Society. Please use thereverse side for your additional comments.

    Please do not complete or sign the recommendation unless the student hascompleted the top part of this form.

    Signature_________________________________________Date___________

    Please return toMs. Bunces mailbox before September 25, 2012

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    National Honor Society

    Jackson Chapter

    Advisor Recommendation

    S e p t e m b e r 6 , 2 0 1 2

    D e a r A d v i s o r ,

    T h e s t u d e n t s n a m e o n t h e a t t a c h e d s h e e t h a s i n d i c a t e d t h a t y o u w e r e a

    c o a c h / a c t i v i t y a d v i s o r f o r a s c h o o l o r c o m m u n i t y a c t i v i t y a t s o m e p o i n t

    d u r i n g h i s / o r h e r h i g h s c h o o l y e a r s .

    T h i s s t u d e n t i s a c a n d i d a t e f o r a d m i s s i o n i n t o t h e N a t i o n a l H o n o r S o c i e t y ,

    a n d y o u r v e r i f i c a t i o n o f p a r t i c i p a t i o n i n t h e l i s t e d a c t i v i t y i s e s s e n t i a l t o

    t h e s e l e c t i o n p r o c e s s . S t u d e n t s s e l e c t e d f o r a d m i s s i o n m u s t h a v e

    d e m o n s t r a t e d s u p e r i o r s c h o l a r s h i p . T o c o m p l e m e n t t h e i r a c a d e m i c

    a c c o m p l i s h m e n t s , s t u d e n t s m u s t d e m o n s t r a t e s u s t a i n e d i n t e r e s t ,

    e f f o r t , a n d a c h i e v e m e n t i n e x t r a c u r r i c u l a r a c t i v i t i e s o r v o l u n t e e r w o r k .

    W e a s k t h a t y o u v e r i f y t h i s s t u d e n t s p a r t i c i p a t i o n a n d c o n t r i b u t i o n t o y o u r

    a c t i v i t y .

    I f y o u a r e a s t a f f m e m b e r h e r e a t t h e h i g h s c h o o l , p l e a s e r e t u r n t h ei n f o r m a t i o n t o m y m a i l b o x b y S e p t e m b e r 2 5 , 2 0 1 2 . I f y o u a r e c o m m u n i t y

    m e m b e r , k i n d l y f a x t o 7 3 2 - 8 3 3 - 4 6 7 9 o r m a i l t o :

    M s . K a t h l e e n B u n c e

    N a t i o n a l H o n o r S o c i e t y A d v i s o r

    J a c k s o n M e m o r i a l H i g h S c h o o l

    1 0 1 D o n C o n n o r B o u l e v a r d

    J a c k s o n , N J 0 8 5 2 7

    T h a n k y o u f o r y o u r c o o p e r a t i o n ,

    S i n c e r e l y ,

    K a t h l e e n A . B u n c e

    N a t i o n a l H o n o r S o c i e t y A d v i s o r

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    National Honor SocietyJackson Chapter

    Student: Please complete your name, name of the advisor, and the name ofthe activity before giving the recommendation to the advisor.

    Name of Candidate________________________________________________Name of Advisor Writing Recommendation____________________________Name of Activity (be specific) _______________________________________Dates of participation in activity______________________________________

    Please check the appropriate box (5 is best)

    1 2 3 4 5

    SERVICE:

    Attended at Least 75% ofmeetings or classes

    Willingly helped out beyondminimal requirements

    Fulfilled committed obligations

    LEADERSHIP:Took initiative

    Exhibited growth in self-confidence

    Led a committee or activity

    Held positions of responsibility

    Promoted the groups activities

    Was a positive influence

    Worked well with othersFollowed through on tasks

    CHARACTER:Reliable

    Responsible

    Honest

    Sincere and courteous

    TOTAL NUMERIC SCORE: ____________

    Please return to Ms. Bunce before October 5, 2012

    Signature_________________________________________Date___________________

    *Daytime Phone:______________________________*Evening Phone_________________*Required for Community Advisors Only

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    National Honor Society

    Jackson Chapter

    Advisor Recommendation

    S e p t e m b e r 6 , 2 0 1 2

    D e a r A d v i s o r ,

    T h e s t u d e n t s n a m e o n t h e a t t a c h e d s h e e t h a s i n d i c a t e d t h a t y o u w e r e a

    c o a c h / a c t i v i t y a d v i s o r f o r a s c h o o l o r c o m m u n i t y a c t i v i t y a t s o m e p o i n t

    d u r i n g h i s / o r h e r h i g h s c h o o l y e a r s .

    T h i s s t u d e n t i s a c a n d i d a t e f o r a d m i s s i o n i n t o t h e N a t i o n a l H o n o r S o c i e t y ,

    a n d y o u r v e r i f i c a t i o n o f p a r t i c i p a t i o n i n t h e l i s t e d a c t i v i t y i s e s s e n t i a l t o

    t h e s e l e c t i o n p r o c e s s . S t u d e n t s s e l e c t e d f o r a d m i s s i o n m u s t h a v e

    d e m o n s t r a t e d s u p e r i o r s c h o l a r s h i p . T o c o m p l e m e n t t h e i r a c a d e m i c

    a c c o m p l i s h m e n t s , s t u d e n t s m u s t d e m o n s t r a t e s u s t a i n e d i n t e r e s t ,

    e f f o r t , a n d a c h i e v e m e n t i n e x t r a c u r r i c u l a r a c t i v i t i e s o r v o l u n t e e r w o r k .

    W e a s k t h a t y o u v e r i f y t h i s s t u d e n t s p a r t i c i p a t i o n a n d c o n t r i b u t i o n t o y o u r

    a c t i v i t y .

    I f y o u a r e a s t a f f m e m b e r h e r e a t t h e h i g h s c h o o l , p l e a s e r e t u r n t h e

    i n f o r m a t i o n t o m y m a i l b o x b y O c t o b e r 5 , 2 0 1 2 . I f y o u a r e c o m m u n i t y

    m e m b e r , k i n d l y f a x t o 7 3 2 - 8 3 3 - 4 6 7 9 o r m a i l t o :

    M s . K a t h l e e n B u n c e

    N a t i o n a l H o n o r S o c i e t y A d v i s o r

    J a c k s o n M e m o r i a l H i g h S c h o o l

    1 0 1 D o n C o n n o r B o u l e v a r d

    J a c k s o n , N J 0 8 5 2 7

    T h a n k y o u f o r y o u r c o o p e r a t i o n ,

    S i n c e r e l y ,

    K a t h l e e n A . B u n c e

    N a t i o n a l H o n o r S o c i e t y A d v i s o r

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    National Honor SocietyJackson Chapter

    Student: Please complete your name, name of the advisor, and the name ofthe activity before giving the recommendation to the advisor.

    Name of Candidate________________________________________________Name of Advisor Writing Recommendation____________________________Name of Activity (be specific) _______________________________________Dates of participation in activity______________________________________

    Please check the appropriate box (5 is best)

    1 2 3 4 5

    SERVICE:

    Attended at Least 75% ofmeetings or classes

    Willingly helped out beyondminimal requirements

    Fulfilled committed obligations

    LEADERSHIP:Took initiative

    Exhibited growth in self-confidence

    Led a committee or activity

    Held positions of responsibility

    Promoted the groups activities

    Was a positive influence

    Worked well with othersFollowed through on tasks

    CHARACTER:Reliable

    Responsible

    Honest

    Sincere and courteous

    TOTAL NUMERIC SCORE: ____________

    Please return to Ms. Bunce before October 5, 2012

    Signature_________________________________________Date___________________

    *Daytime Phone:______________________________*Evening Phone_________________

    *Required for Community Advisors Only

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    National Honor Society

    Jackson Chapter

    Advisor Recommendation

    S e p t e m b e r 6 , 2 0 1 2

    D e a r A d v i s o r ,

    T h e s t u d e n t s n a m e o n t h e a t t a c h e d s h e e t h a s i n d i c a t e d t h a t y o u w e r e a

    c o a c h / a c t i v i t y a d v i s o r f o r a s c h o o l o r c o m m u n i t y a c t i v i t y a t s o m e p o i n t

    d u r i n g h i s / o r h e r h i g h s c h o o l y e a r s .

    T h i s s t u d e n t i s a c a n d i d a t e f o r a d m i s s i o n i n t o t h e N a t i o n a l H o n o r S o c i e t y ,

    a n d y o u r v e r i f i c a t i o n o f p a r t i c i p a t i o n i n t h e l i s t e d a c t i v i t y i s e s s e n t i a l t o

    t h e s e l e c t i o n p r o c e s s . S t u d e n t s s e l e c t e d f o r a d m i s s i o n m u s t h a v e

    d e m o n s t r a t e d s u p e r i o r s c h o l a r s h i p . T o c o m p l e m e n t t h e i r a c a d e m i c

    a c c o m p l i s h m e n t s , s t u d e n t s m u s t d e m o n s t r a t e s u s t a i n e d i n t e r e s t ,

    e f f o r t , a n d a c h i e v e m e n t i n e x t r a c u r r i c u l a r a c t i v i t i e s o r v o l u n t e e r w o r k .

    W e a s k t h a t y o u v e r i f y t h i s s t u d e n t s p a r t i c i p a t i o n a n d c o n t r i b u t i o n t o y o u r

    a c t i v i t y .

    I f y o u a r e a s t a f f m e m b e r h e r e a t t h e h i g h s c h o o l , p l e a s e r e t u r n t h e

    i n f o r m a t i o n t o m y m a i l b o x b y O c t o b e r 5 , 2 0 1 2 . I f y o u a r e c o m m u n i t y

    m e m b e r , k i n d l y f a x t o 7 3 2 - 8 3 3 - 4 6 7 9 o r m a i l t o :

    M s . K a t h l e e n B u n c e

    N a t i o n a l H o n o r S o c i e t y A d v i s o r

    J a c k s o n M e m o r i a l H i g h S c h o o l

    1 0 1 D o n C o n n o r B o u l e v a r d

    J a c k s o n , N J 0 8 5 2 7

    T h a n k y o u f o r y o u r c o o p e r a t i o n ,

    S i n c e r e l y ,

    K a t h l e e n A . B u n c e

    N a t i o n a l H o n o r S o c i e t y A d v i s o r

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    National Honor SocietyJackson Chapter

    Student: Please complete your name, name of the advisor, and the name ofthe activity before giving the recommendation to the advisor.

    Name of Candidate________________________________________________Name of Advisor Writing Recommendation____________________________Name of Activity (be specific) _______________________________________Dates of participation in activity______________________________________

    Please check the appropriate box (5 is best)

    1 2 3 4 5

    SERVICE:

    Attended at Least 75% ofmeetings or classes

    Willingly helped out beyondminimal requirements

    Fulfilled committed obligations

    LEADERSHIP:Took initiative

    Exhibited growth in self-confidence

    Led a committee or activity

    Held positions of responsibility

    Promoted the groups activities

    Was a positive influence

    Worked well with othersFollowed through on tasks

    CHARACTER:Reliable

    Responsible

    Honest

    Sincere and courteous

    TOTAL NUMERIC SCORE: ____________

    Please return to Ms. Bunce before October 5, 2012

    Signature_________________________________________Date___________________

    *Daytime Phone:______________________________*Evening Phone_________________*Required for Community Advisors Only

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    Thirty Hour Service Validation Form(Complete a form for each activity)

    For (Name): __________________________________

    Name of Agency ______________________________

    Address ____________________________________

    ____________________________________

    Phone Number _______________________________

    Name of Contact Person _______________________

    1. Date of Service ______________ Hours Completed ________

    Description of Service _________________________________________

    ___________________________________________________________

    ___________________________________________________________

    2. Date of Service ______________ Hours Completed ________

    Description of Service _________________________________________

    ___________________________________________________________

    ___________________________________________________________

    3. Date of Service ______________ Hours Completed ________

    Description of Service _____________________________________

    ___________________________________________________________

    ___________________________________________________________

    I, ____________________________________, attest that the applicant listed above hascompleted the service as described.

    Signature of Contact Person _________________________________ Date:__________

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    Thirty Hour Service Validation Form(Complete a form for each activity)

    For (Name): __________________________________

    Name of Agency ______________________________

    Address ____________________________________

    ____________________________________

    Phone Number _______________________________

    Name of Contact Person _______________________

    1. Date of Service ______________ Hours Completed ________

    Description of Service _________________________________________

    ___________________________________________________________

    ___________________________________________________________

    2. Date of Service ______________ Hours Completed ________

    Description of Service _________________________________________

    ___________________________________________________________

    ___________________________________________________________

    3. Date of Service ______________ Hours Completed ________

    Description of Service _____________________________________

    ___________________________________________________________

    ___________________________________________________________

    I, ____________________________________, attest that the applicant listed above hascompleted the service as described.

    Signature of Contact Person Date: