National Honor Society Character Reference Form for the National Honor Society Student’s Full Name: _____________________________________________________________ Grade: _________ I understand that this character reference is conﬁdential and will not be released to myself, family, or a third party, and it will be used only in the evaluation of my candidacy for Laurel Springs School’s Chapter of the National Honor Society. Student’s Signature: ______________________________________________________ Date: ___________________ Instructions for Recommender The person completing this Character Reference should be an adult [non-relative] who has supervised the student in some speciﬁc activity of service or leadership. We are interested primarily in the student’s character, proven service record, and the ability of the student to be a leader in his or her community. We value your comments and insight regarding this student. Your opinion is very important to us and will be an integral element in our decision process. Recommender’s Name: _______________________________________________________________________ Title (if applicable): __________________________________________________________________________ Email: ____________________________________________ Phone Number: ____________________________ Signature: _______________________________________________________ Date: _____________________ Rating Compared to other students, how would you rate this student in terms of the following? (Please use a X to denote rating.) Below Average Acceptable Above Average Excellent Outstanding No Basis Personal Qualities and Character Leadership Service Record Academic Achievement Overall LaurelSprings.com (800) 377-5890 page 1 of 2 0315 National Honor Society As you answer the following questions regarding the named student, please be speciﬁc. 1. How long have you known this student and in what context? 2. How would you describe this student’s character, personal qualities, and maturity level? 3. How has the student demonstrated leadership qualities? 4. How has the student contributed to the community, either on a local or global level? 5. Is there anything else you think we should know about the student that would contribute to his or her application? This form is due by April 1, 2015 Please return via email to: [email protected] Or mail to: Laurel Springs School, Attention: National Honor Society 1615 West Chester Pike, Suite 200, West Chester, PA 19382 LaurelSprings.com (800) 377-5890 page 2 of 2