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NHS Selection Packet Checklist
Did you remember to....
 Paperclip everything together?
 Give evaluations to teachers?
Include your...
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Parent/Guardian Consent Form?
NHS Selection Packet Cover Sheet?
Detailed Leadership Experiences?
Detailed Co-curricular Experiences?
Detailed Service Experiences?
Recognition and Awards?
Work Experience?
Typed Student Essay?
Gather your personal reference forms in envelopes with your
student number on the front and their signature placed OVER
the sealed envelope flap?
DUE Friday May 15th @ 2:30pm!
NO EXCUSES!!
Details
Membership:
Selection to the National Honor Society represents the highest honor and trust that can be bestowed
upon a student in the junior or senior year of high school. The National Honor Society recognizes
students for outstanding CHARACTER, SCHOLARSHIP, LEADERSHIP, and SERVICE. Membership
in the society is indicative that the student has attained and is demonstrating and promoting all of
these qualities, and is exerting an effort to improve conditions in the school and community. Meeting
the grade point average requirement is not the sole criteria for acceptance into the National Honor
Society. Schools that select members solely on the basis of scholarship are placing their charters in
jeopardy for it violates the Constitution of the NHS. Evidence that you meet the qualifications of
LEADERSHIP, CHARACTER, and SERVICE requirements are necessary to be eligible for
membership.
Selection for membership is by a faculty review of candidates and is based on outstanding
scholarship, character, leadership, and service. Once selected, members have the responsibility to
continue to demonstrate these qualities. Members who resign or are dismissed are no longer eligible
for membership or its benefits and they may not reapply for membership.
Selection of Members:
1)
To be eligible for membership the candidate must be a member of the junior or senior class.
2)
The selection of members to the chapter shall be by a majority vote of the faculty council.
Scholarship Requirements:
All candidates must have a minimum cumulative non-rounded weighted grade point average (GPA) of
3.5.
Character, Leadership, and Service Requirements:
Students will be asked to detail their character, leadership, and service experiences while attending
Brandon High School. All candidates will be required to submit one essay. Students may be called in
for an interview by the faculty council if more information is needed or if clarification is needed. Any
conduct violations during enrollment at Brandon High School will impact your eligibility for
membership.
The following is not an official NHS document. It is to be used as a guide only. It is a list of leadership
and service activities compiled by past NHS members. It is not a complete list and is subject to
change as the needs of the community and the activities of the students change. If you have
questions about a particular activity, please see the NHS advisors.
Leadership
Each of these activities may or may not exemplify leadership depending upon your role in the
activity.
● Class Board/Student Council Officers
● Class Board/Student Council Committee chairs and members-at-large who take on leadership
roles.
● Newspaper/Yearbook Editor positions
● Peer Mediation
● Drama club leadership roles
● Band and Choir leadership roles
● Club Officer
● Committee Chair
● Work related leadership roles; manager, team leader, supervisor, etc
● Athletic Team Captains
● Coach/Assistant Coach for youth teams
● Special Olympics Coach
● Summer camp counselors
● Organizing special events; animal shows and holiday parties for special needs children,
disabled or elderly, charity concession stands, etc.
● Leadership activities associated with community based, cultural or religious youth groups. Be
specific when defining your leadership role in these activities.
Activities that do not qualify as leadership activities for NHS.
● Everyday classroom behaviors*
● Classroom/activity role model positions*
● Participation in events and activities*
* This does not mean that these are unimportant. Your teachers will score your classroom leadership.
Low scores could be the cause of non-selection.
Action verbs that may describe leadership:
Achieved
Administered
Advised
Appointed
Assembled
Assessed
Assigned
Attained
Authorized
Chaired
Challenged
Changed
Coached
Conducted
Coordinated
Counseled
Created
Decided
Delegated
Delivered
Designated
Developed
Devised
Directed
Distributed
Educated
Employed
Energized
Engineered
Enlisted
Established
Executed
Expanded
Facilitated
Finalized
Followed
through
Formed
Formulated
Founded
Generated
Governed
Grouped
Guided
Handled
Headed
Hired
Identified
Implemented
Improvised
Incorporated
Informed
Initiated
Instituted
Instructed
Integrated
Intervened
Introduced
Issued
Launched
Led
Made
Maintained
Managed
Mediated
Mentored
Motivated
Organized
Oversaw
Planned
Prioritized
Recommended
Scheduled
Supervised
United
Service
Service is an important part of NHS. For your selection, you should include all service hours you have
completed since the beginning of your 9th grade year.
Examples of community service may include:
Volunteering at an animal shelter (like MARL K-9 Rescue League)
Hospital volunteer
Seasonal charity work wrapping presents
Individually arranged private tutoring for which no compensation is given
Volunteering at a soup kitchen
Translator for ESL, brail, etc.
Participating in any scheduled DNR workday (Remember that you must bring the waiver found here)
Donating blood on your own time
Meals on Wheels
O.A.T.S.
Promise Village
CrittenTeen program
Working with elderly senior citizens
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Nursing home volunteer
Retirement home volunteer
Planting flowers at a nursing home
Organizing transportation
Delivering groceries
Yard work (Snow shoveling, raking leaves, mowing lawns, planting flowers, pulling weeds, etc.)
Shelter or hotline volunteers/counselors
Salvation Army volunteer
Volunteer for Special Olympics
Mission trips (counting only the hours spent directly helping others in need)
Girl Scout / Eagle Scout projects that benefit the community at large
Habitat for Humanity construction build volunteer
Church work that reaches beyond a specific denomination and is not preaching in nature
(Please note: Church work must reach beyond the church itself and have a direct and clear path as to
how the service benefits the community at large. Bible school, singing in the choir, babysitting during
services, volunteering as a parking attendant during church events, cleaning your church, Sunday School
Teachers, are all applauded, but they are not used for the purpose of NHS community service
requirements. Examples that would be appropriate include: Youth groups building homes for Habitat for
Humanity, youth groups volunteering at Gleaners food bank, fundraisers where all funds or items
collected go directly to a charity serving the community at large, etc.)
Exceptions - Activities that are not used for the purpose of meeting community service requirements:
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Anything for which you were paid.
Anything that is a family obligation (babysitting, household chores, etc.).
Athletic Team Captains or managers functions performed as a team captain/manager that are
routine responsibilities of the team members or coaches; ie, cleaning-up after events or set-up
prior.
Set-up and clean-up for routine meetings, events, etc for clubs and organizations for which you are
a member.
Taking part in ceremonies and meetings for organizations for which you are a member even if that
organization is a service organization.
The planning and leadership functions involved in membership in community service organizations
are responsibilities of your membership in the organization and not community service per se.
Babysitting for parents, relatives, or neighbors with or without pay. (Babysitting without pay may
qualify under special circumstances; to allow adults to participate in service activities, financial,
physical or emotional hardships, etc.)
Assisting parents with youth groups for younger siblings unless a specific and necessary function
is filled: ie, another person other than the parent would have to complete your task. (In general,
assisting parents or relatives is not community service.)
Giving computer assistance to neighbors unless that neighbor is disabled or elderly and unable to
travel to or obtain assistance through normal means.
Assisting any person with their paid employment or at their place of employment (i.e. Helping a
teacher pack, unpack, clean a classroom, computer help, make copies, grade papers, daycare,
teacher assistant, library assistant, secretarial assistant, custodial assistant, etc. or any other task
that is part of the individuals paid responsibilities does not qualify for the purposes of NHS
approved service.)
Fund-raising for an organization, unless the purpose of the fundraiser is to raise funds for charity.
Fasting or going without sleep to raise public awareness is not community service. Only the hours
in which you were engaged in actual community service activities may be counted.
Gray areas exist - to help clarify ask yourself - "Am I participating in this activity for personal reasons
other than to help others? Would I do it for myself (friends or family) even if no other persons would
benefit?" If so, then you should not count it as service.
The following information will help you in completing your NHS packet.
1. Fill out each section completely and to the best of your ability. Do not be modest about your
accomplishments. All information will be used to help make your way into NHS. Do not feel limited by the
amount of space provided. Please be aware that neatness of presentation is considered. Faculty council will be
inspecting the quality and professional look of your finished selection packet. Sell yourself!
2. You MUST have signatures on everything! Ask club sponsors and coaches to sign the page listing
extracurricular activities. You must have signatures and phone numbers for all references and any service
hours listed. Any activity without appropriate documentation will be considered void.
If you cannot get a face-to-face meeting with the person whose signature you need, you may have them scan
& email something (either to you or the school). The NHS email address is [email protected].
It is imperative that all four sections (leadership, co-curricular, scholarship, & community service) demonstrate
the candidate’s accomplishments. If any of these sections are blank, Faculty Council will summarily reject the
packet.
3. You will be known to the faculty council only by student number. Remember, you must be referred to as “this
candidate” or by “he” or “she” by those who are completing references for you. No names! This must remain
anonymous.
Example: “This candidate is an excellent choice for NHS. She exhibits leadership and has volunteered in our
community soup kitchen.”
4. Remember, there are 3 teacher recommendations and 3 outside-of-school recommendations. They
must be 6 different people who are at least 21 years of age. Recommendations may not be from a relative.
The 3 teacher recommendations need to be completed by teachers you had during this school year. You must
have been a student for at least one full trimester course. Remember that faculty council is looking for
candidates that are well-rounded. We recommend that the letters come from teachers in three different subject
areas. Before handing out your teacher evaluations you need to:
1) Fill out the “To be filled out by Candidate” section of the evaluation form.
2) Place the evaluation form in an envelope.
3) Write your name on the front of the envelope. This is the only way your teacher will connect
your name to your evaluation form.
It is required that you hand in 3 recommendations from individuals who know you well. Identify people in the
community or school who can attest to the Leadership, the Character, and/or the Service that you have
provided over the past two years. Provide him/her with a copy of the “personal reference form” as well as an
envelope that displays your student number on the front and have him/her sign the sealed envelope. Their
signature goes OVER the flap indicating they sealed the envelope, not your signature. Return the envelopes
with your packet.
5. Plan ahead. Don’t wait until the last minute. This selection packet is due no later than Friday, May 15, 2015
at 2:30pm. ANY candidate who fails to meet this deadline will no longer be considered a candidate for NHS.
The induction for candidates selected for membership will be held in the Fall. Additional details will be provided
at a later time.
Parent/Guardian Consent Form
Name of Activity: NHS - National Honors Society
Sponsor's Name: Mrs. Mirolli & Mrs. Dzbanski, teachers
Sponsor Contact for selection questions: [email protected]
Description of Program: NHS is an organization that is built for four areas: leadership, scholarship, service, and
character. The Brandon High School Chapter seeks to provide activities and services for the betterment of the
entire school community.
Criteria/Eligibility Requirements: 3.5 G.P.A. at the beginning of junior or senior year. Selection packet
reviewed by the faculty council highlighting the candidate’s outstanding character, service, and leadership.
Size of Group: Varies
Duration: Before, during, and/or after school
Time of Year: Year-Round
We have reviewed this packet & the attached cover letter. We are aware of the requirements for selection &
recognize that failure to comply with these standards will disqualify student eligibility. We understand that
acceptance or rejection is based solely on the candidate informational packet as student numbers are
the only means of student identification. We understand that staff appointed by the high school Principal, Mr.
Stevens, will review each candidate. We also understand that students selected for the National Honor Society
must attend all meetings & functions as required. We recognize that students will be required to perform
service hours each month & may be removed from the Society for failing to meet these requirements. If we
have questions about anything involving the selections, we will contact Mrs. Mirolli or Mrs. Dzbanski.
Completed Packets - due May 15, 2015 at 2:30 pm
(NO LATE CANDIDATE PACKETS WILL BE CONSIDERED)
Induction Ceremony - Fall of 2011 in the Performing Arts Center.
Print Student Name as you’d like it on the certificate:_____________________________________
Student Street Address: __________________________ City: ______________ Zipcode: ________
Parent Name (Please print): _________________________________________________________
Student Signature: ________________________________ Student Number:___________________
Parent Signature:__________________________________________________
NHS Candidate Information: Cover Sheet
Have you ever been subjected to disciplinary action by BHS? (Please list any detentions and explain
the circumstances)
□
YES □ NO
IF YOU ANSWERED "YES" ABOVE, EXPLAIN FULLY ON A SEPARATE SHEET OF PAPER.
In the space below, please list the names of the three teachers you have asked for teacher
evaluations:
1. __________________________________
2. __________________________________
3. __________________________________
I understand that submitting this informational packet does not guarantee placement into the National
Honor Society at Brandon High School.
I have read the membership guidelines and fully understand that if I’m selected I will uphold all
responsibilities of the National Honor Society. Included in these responsibilities, but not necessarily
limited to, are the following:
1. Punctual attendance at meetings, usually Thursday mornings, 6:50 am at the high school.
2. Completion of 40 service hours from June to May each school year
3. Meeting all documentation deadlines set forth (submission of completed packets, recording
of hours, submission of hours, etc.)
4. Attendance at induction ceremonies for new members
5. Payment of Annual Membership Fee of $20.00
Write student ID number on this line to agree to the terms of NHS membership
#____________________
Date:______________
For faculty council use only:
Date and Time Received: __________________________
Teacher Evaluations: _________
Personal References: ________
Honor Code Violations: Yes or No
If yes, description:
LEADERSHIP EXPERIENCES
Please list evidence of LEADERSHIP activities that you have engaged in during high school in
order of significance. Please be specific and do not assume the reviewers have knowledge of your
leadership activities.
LEADERSHIP POSITIONS: List all elected or appointed leadership positions held in school,
community, or work activities. Only those positions in which you were directly responsible for directing
or motivating others should be included. In order to count toward the leadership criteria you must:
1) document your leadership role,
2) provide a description of the leadership skills,
3) provide the name and contact information of the adult in charge, and
4) signature of adult in charge.
Grades
9,10,11
Name of
Leadership
Role
Detailed description
Name of
supervising
adult and
contact
information
Signature
Any additional leadership experiences should be recorded on a separate sheet and attached.
CO-CURRICULAR EXPERIENCES
CO-CURRICULAR ACTIVITIES: List all activities in which you have participated during high school.
Include clubs, teams, jobs, musical groups, or other organizations and major accomplishments in
each. Signatures are required for each activity listed, and faculty council wants to see diversity.
Example:
Grade
9,10,11
9 -10
Years
9,10, 11
Name of
Activity
Football
Team
Name of
Activity
Detailed description
I participated in scheduled
practices and regulation games.
There were days when our
practices would be cancelled
during bad weather so I created
a text message fan-out list to
better inform players.
Detailed description
Name of supervising
adult and contact
information
Signature
Mr. Pizzala
[email protected]
Name of supervising
adult and contact
information
Signature
Any additional co-curricular experiences should be recorded on a separate sheet and attached.
SERVICE EXPERIENCES
List any service activities in which you have participated during your high school years. These can
be service projects done with a group either in or out of school or done individually.
**Generally speaking, service activities are those which are done for, or on behalf of others (not
including family members) for which there is no compensation given or course credit received.
Please look to the “details - service section for more help in determining what may qualify as service.
For each service activity you must provide the following:
1) the name of the charity, organization and/or activity,
2) the number of hours you were engaged in the activity,
3) a detailed description of the service you provided,
4) the name and contact information of the adult in charge, and
5) signature of adult in charge.
Date
Name of
charity
Number
of hours
Detailed description
Name of
supervising
adult and
contact
information
Signature
Any additional service experiences should be recorded on a separate sheet and attached.
RECOGNITION AND AWARDS
List below any honors, awards, or recognition you have received during your high school years that
support your bid to be selected for National Honor Society. Please do not repeat participation in other
activities if they are listed elsewhere on this form.
Grades
9,10,11
Name of Award
Detailed description
Candidates must
provide a digital
picture of the award
or a copy of the
award certificate or
letter as proof of
recognition.
You may include pictures and/or copies of your award certificates and trophies. Please be aware that
anything submitted will not be returned.
WORK EXPERIENCE
List below any job or work experience you have. This work experience may be paid or volunteer.
Please include a list of the number of hours spent on the job or activity and a brief description of what
you have accomplished. Also, in this section you may include any additional information that is not
already noted on the form, which you feel is important for the selection committee to know when they
are considering you as a member. Please do not repeat participation in other activities if they are
listed elsewhere on this form.
Grades
9,10,11
Name of Employer
and Your Position
Number of
hours
Job Description
Name of
supervising
adult and
contact
information
Any additional Awards or Work Experiences should be recorded on a separate sheet and attached.
Student Essay
On a separate piece of paper, type a well developed one to two page essay in response to the
following prompt:
Leadership, Character, Service, and Scholarship are the four pillars of the
National Honor Society. Explain how you exemplify each of the four
pillars. Be specific and site examples of past personal experiences.
National Honor Society TEACHER EVALUATION
Please return to Mrs. Mirolli or Mrs. Dzbanski, by Friday May 15, 2015
To be completed by the Candidate:
Teacher's Name: _____________________ Student ID # __________________
Did you have this teacher during 1st semester of the 2014-2015 school year? ______________
For what class? ___________________
To be completed by the Teacher: Date you received evaluation: ______________________
● Please take some time to complete this form for the student who has asked you for your
evaluation. Your judgment will help the Faculty Council determine the membership of the
National Honor Society.
● You must refer to the student by their student number. Please do not return this to the
student.
Please circle the word listed after the characteristic that best describes the student.
1. Capacity for work
excellent
average
poor
2. Self-control
excellent
average
poor
3. Initiative
excellent
average
poor
4. Attitude
excellent
average
poor
5. Ability to work w/ others
excellent
average
poor
6. Reliability
excellent
average
poor
7. General conduct
excellent
average
poor
8. Motivation
excellent
average
poor
9. Attendance
excellent
average
poor
Faculty Council needs to know the reason for your rating of poor. Please use the space below
to comment or elaborate on any poor rating.
I would recommend this student for NHS. (Circle one) YES
NO
PLEASE GIVE A FEW COMMENTS WHETHER THEY BE POSITIVE OR NEGATIVE. THEY ARE
EXTREMELY HELPFUL TO FACULTY COUNCIL. Please do not use the student’s name.
Teacher Signature:____________________________________________
National Honor Society TEACHER EVALUATION
Please return to Mrs. Mirolli or Mrs. Dzbanski, by Friday May 15, 2015
To be completed by the Candidate:
Teacher's Name: _____________________ Student ID # __________________
Did you have this teacher during 1st semester of the 2014-2015 school year? ______________
For what class? ___________________
To be completed by the Teacher: Date you received evaluation: ______________________
● Please take some time to complete this form for the student who has asked you for your
evaluation. Your judgment will help the Faculty Council determine the membership of the
National Honor Society.
● You must refer to the student by their student number. Please do not return this to the
student.
Please circle the word listed after the characteristic that best describes the student.
1. Capacity for work
excellent
average
poor
2. Self-control
excellent
average
poor
3. Initiative
excellent
average
poor
4. Attitude
excellent
average
poor
5. Ability to work w/ others
excellent
average
poor
6. Reliability
excellent
average
poor
7. General conduct
excellent
average
poor
8. Motivation
excellent
average
poor
9. Attendance
excellent
average
poor
Faculty Council needs to know the reason for your rating of poor. Please use the space below
to comment or elaborate on any poor rating.
I would recommend this student for NHS. (Circle one) YES
NO
PLEASE GIVE A FEW COMMENTS WHETHER THEY BE POSITIVE OR NEGATIVE. THEY ARE
EXTREMELY HELPFUL TO FACULTY COUNCIL. Please do not use the student’s name.
Teacher Signature:____________________________________________
National Honor Society TEACHER EVALUATION
Please return to Mrs. Mirolli or Mrs. Dzbanski, by Friday May 15, 2015
To be completed by the Candidate:
Teacher's Name: _____________________ Student ID # __________________
Did you have this teacher during 1st semester of the 2014-2015 school year? ______________
For what class? ___________________
To be completed by the Teacher: Date you received evaluation: ______________________
● Please take some time to complete this form for the student who has asked you for your
evaluation. Your judgment will help the Faculty Council determine the membership of the
National Honor Society.
● You must refer to the student by their student number. Please do not return this to the
student.
Please circle the word listed after the characteristic that best describes the student.
1. Capacity for work
excellent
average
poor
2. Self-control
excellent
average
poor
3. Initiative
excellent
average
poor
4. Attitude
excellent
average
poor
5. Ability to work w/ others
excellent
average
poor
6. Reliability
excellent
average
poor
7. General conduct
excellent
average
poor
8. Motivation
excellent
average
poor
9. Attendance
excellent
average
poor
Faculty Council needs to know the reason for your rating of poor. Please use the space below
to comment or elaborate on any poor rating.
I would recommend this student for NHS. (Circle one) YES
NO
PLEASE GIVE A FEW COMMENTS WHETHER THEY BE POSITIVE OR NEGATIVE. THEY ARE
EXTREMELY HELPFUL TO FACULTY COUNCIL. Please do not use the student’s name.
Teacher Signature:____________________________________________
National Honor Society Personal Reference Form
Directions to Writer: Brandon High School is in the process of selecting National Honor Society members.
Because help to the community is a large part of NHS, this form's purpose is to request your input as a
member of the community. We would like your feedback as to the Leadership, the Character, and the Service
this candidate has demonstrated. Information you provide will shine light on the background of this NHS
candidate.
Please refer to the candidate by their number. #____________________________
We do this to ensure the selection process is objective when we evaluate the information provided. This helps
the process to be fair and equitable. THANK YOU!
Phone Number:
Date:
Relation:
How long have you known the candidate?
Please rate this student in the below categories according to how you see fit (4 being the highest, 0 indicating
trait poorly displayed, N/A trait is not relevant to this circumstance). Please give reasoning behind your rating.
An informational description of the NHS requirements has been placed on page two.
Circle Leadership:
4 3 2 1 0 N/A
Reasoning -
Circle Character:
4 3 2 1 0 N/A
Reasoning -
Circle Service:
4 3 2 1 0 N/A
Reasoning Please provide any other information that could help this student’s selection into NHS on the back of this page.
This may include:
● The candidate's commitment to service
● The nature of the activities
● How this person demonstrated leadership in events or organizations
● Additional comments about the CHARACTER (honesty, reliability, etc.) of the candidate.
Writer's Name: _____________________________________
Signature of Writer: __________________________________ Date:____________
Please seal the envelope, sign over the flap & return it to the candidate in the envelope provided.
Personal Reference Pg. 2
LEADERSHIP
● A National Honor Society member is resourceful in purposing new problems, applying
principles, and making suggestions.
● Demonstrates leadership in promoting school activities.
● Exercises influence on peers in upholding school ideas. Contributes ideas that improve the
civic life of school.
● Exemplifies positive attitudes and inspires positive behavior in others. Demonstrates academic
initiative.
● Successfully holds school offices and positions of responsibility. Is thoroughly dependable in
and responsibility accepted.
CHARACTER
● A National Honor Society member takes criticism willingly and accepts recommendations
graciously.
● Constantly exemplifies desirable qualities of personality. Upholds principles of morality and
ethics.
● Cooperates by complying with school regulations. Demonstrates the highest standards of
honesty and reliability.
● Shows courtesy, concern, and respect for others. Observes instructions and rules and
punctuality both in and out of the classroom.
● Has powers of concentration and sustained attention as shown by perseverance and
application to studies.
SERVICE
● A National Honor Society member is willing to uphold scholarship and maintain a loyal school
attitude.
● Participates in some outside activities: Girl Scouts, Boy Scouts, church groups, and volunteer
services for the aged and poor.
● Volunteers dependable and well-organized assistance, is gladly available, and is willing to offer
assistance.
● Works well with others and is willing to take on difficult and inconspicuous responsibilities.
● Cheerfully and enthusiastically renders any requested service to the school.
● Does committee and staff work uncomplainingly. Shows courtesy by assisting visitors,
teachers, and students.
SCHOLARSHIP
● A National Honor Society member has a grade point average of 3.5 or better.
National Honor Society Personal Reference Form
Directions to Writer: Brandon High School is in the process of selecting National Honor Society members.
Because help to the community is a large part of NHS, this form's purpose is to request your input as a
member of the community. We would like your feedback as to the Leadership, the Character, and the Service
this candidate has demonstrated. Information you provide will shine light on the background of this NHS
candidate.
Please refer to the candidate by their number. #____________________________
We do this to ensure the selection process is objective when we evaluate the information provided. This helps
the process to be fair and equitable. THANK YOU!
Phone Number:
Date:
Relation:
How long have you known the candidate?
Please rate this student in the below categories according to how you see fit (4 being the highest, 0 indicating
trait poorly displayed, N/A trait is not relevant to this circumstance). Please give reasoning behind your rating.
An informational description of the NHS requirements has been placed on page two.
Circle Leadership:
4 3 2 1 0 N/A
Reasoning -
Circle Character:
4 3 2 1 0 N/A
Reasoning -
Circle Service:
4 3 2 1 0 N/A
Reasoning Please provide any other information that could help this student’s selection into NHS on the back of this page.
This may include:
● The candidate's commitment to service
● The nature of the activities
● How this person demonstrated leadership in events or organizations
● Additional comments about the CHARACTER (honesty, reliability, etc.) of the candidate.
Writer's Name: _____________________________________
Signature of Writer: __________________________________ Date:____________
Please seal the envelope, sign over the flap & return it to the candidate in the envelope provided.
Personal Reference Pg. 2
LEADERSHIP
● A National Honor Society member is resourceful in purposing new problems, applying
principles, and making suggestions.
● Demonstrates leadership in promoting school activities.
● Exercises influence on peers in upholding school ideas. Contributes ideas that improve the
civic life of school.
● Exemplifies positive attitudes and inspires positive behavior in others. Demonstrates academic
initiative.
● Successfully holds school offices and positions of responsibility. Is thoroughly dependable in
and responsibility accepted.
CHARACTER
● A National Honor Society member takes criticism willingly and accepts recommendations
graciously.
● Constantly exemplifies desirable qualities of personality. Upholds principles of morality and
ethics.
● Cooperates by complying with school regulations. Demonstrates the highest standards of
honesty and reliability.
● Shows courtesy, concern, and respect for others. Observes instructions and rules and
punctuality both in and out of the classroom.
● Has powers of concentration and sustained attention as shown by perseverance and
application to studies.
SERVICE
● A National Honor Society member is willing to uphold scholarship and maintain a loyal school
attitude.
● Participates in some outside activities: Girl Scouts, Boy Scouts, church groups, and volunteer
services for the aged and poor.
● Volunteers dependable and well-organized assistance, is gladly available, and is willing to offer
assistance.
● Works well with others and is willing to take on difficult and inconspicuous responsibilities.
● Cheerfully and enthusiastically renders any requested service to the school.
● Does committee and staff work uncomplainingly. Shows courtesy by assisting visitors,
teachers, and students.
SCHOLARSHIP
● A National Honor Society member has a grade point average of 3.5 or better.
National Honor Society Personal Reference Form
Directions to Writer: Brandon High School is in the process of selecting National Honor Society members.
Because help to the community is a large part of NHS, this form's purpose is to request your input as a
member of the community. We would like your feedback as to the Leadership, the Character, and the Service
this candidate has demonstrated. Information you provide will shine light on the background of this NHS
candidate.
Please refer to the candidate by their number. #____________________________
We do this to ensure the selection process is objective when we evaluate the information provided. This helps
the process to be fair and equitable. THANK YOU!
Phone Number:
Date:
Relation:
How long have you known the candidate?
Please rate this student in the below categories according to how you see fit (4 being the highest, 0 indicating
trait poorly displayed, N/A trait is not relevant to this circumstance). Please give reasoning behind your rating.
An informational description of the NHS requirements has been placed on page two.
Circle Leadership:
4 3 2 1 0 N/A
Reasoning -
Circle Character:
4 3 2 1 0 N/A
Reasoning -
Circle Service:
4 3 2 1 0 N/A
Reasoning Please provide any other information that could help this student’s selection into NHS on the back of this page.
This may include:
● The candidate's commitment to service
● The nature of the activities
● How this person demonstrated leadership in events or organizations
● Additional comments about the CHARACTER (honesty, reliability, etc.) of the candidate.
Writer's Name: _____________________________________
Signature of Writer: __________________________________ Date:____________
Please seal the envelope, sign over the flap & return it to the candidate in the envelope provided.
Personal Reference Pg. 2
LEADERSHIP
● A National Honor Society member is resourceful in purposing new problems, applying
principles, and making suggestions.
● Demonstrates leadership in promoting school activities.
● Exercises influence on peers in upholding school ideas. Contributes ideas that improve the
civic life of school.
● Exemplifies positive attitudes and inspires positive behavior in others. Demonstrates academic
initiative.
● Successfully holds school offices and positions of responsibility. Is thoroughly dependable in
and responsibility accepted.
CHARACTER
● A National Honor Society member takes criticism willingly and accepts recommendations
graciously.
● Constantly exemplifies desirable qualities of personality. Upholds principles of morality and
ethics.
● Cooperates by complying with school regulations. Demonstrates the highest standards of
honesty and reliability.
● Shows courtesy, concern, and respect for others. Observes instructions and rules and
punctuality both in and out of the classroom.
● Has powers of concentration and sustained attention as shown by perseverance and
application to studies.
SERVICE
● A National Honor Society member is willing to uphold scholarship and maintain a loyal school
attitude.
● Participates in some outside activities: Girl Scouts, Boy Scouts, church groups, and volunteer
services for the aged and poor.
● Volunteers dependable and well-organized assistance, is gladly available, and is willing to offer
assistance.
● Works well with others and is willing to take on difficult and inconspicuous responsibilities.
● Cheerfully and enthusiastically renders any requested service to the school.
● Does committee and staff work uncomplainingly. Shows courtesy by assisting visitors,
teachers, and students.
SCHOLARSHIP
● A National Honor Society member has a grade point average of 3.5 or better.