Please submit all responses typed or in ink
Williamstown High School National Honor Society Squankum Chapter Membership Application Packet 2016-2017
All applications are due on Thursday, November 17 at 2:20 PM and under no circumstances will an application be accepted late. Collection of applications will begin Monday, November 14 in the main office only.
Applicant Name: _____________________________________________________________ Student ID Number: _________________________ Homeroom Section: ________________ Homeroom Teacher: ___________________________ Homeroom Room Number:________
Please submit all responses typed or in ink Final product should be stapled top left and placed in a manila folder
PART A: SCHOOL SERVICE School service is defined as participation in a school-based organization, club, team or faculty sponsored activity. The organization, club, team or other affiliation must have a current Williamstown High School faculty member as the advisor, coach or sponsor. Applicants are required to demonstrate involvement in at least 2 School Service Activities for each year of enrollment. In order to verify participation, applicants are asked to complete the form below and secure initials from the faculty member charged with that organization, club, team or activity. *School Service DOES NOT INCLUDE Scholastic Academies, curricular-based activities or anything not sponsored by a Williamstown High School faculty or staff member. Activity
Years Participated (9, 10, 11, and/or 12)
Example: Italian American Club
9, 10, 11
Name of Faculty Sponsor
Mr. DiCristofaro
If more space is needed attach a duplicate page behind this page
Initial of Faculty Member
PART B: COMMUNITY SERVICE Community service is defined as participation with a community-based organization. Service constitutes an activity to which you receive no monetary or other gains through your participation. If the service was done with an organization not affiliated with WHS you must attach written documentation of your participation from a verifiable source including contact information (a certificate or letter from the person in charge is best). If the service was done through a school organization (example: worked Haunted High School) you would just need the initials from the teacher in charge of that organization. You must provide proof of at least 2 community service activities for each year of enrollment. Failure to provide proof will result in the activity being omitted from consideration in your application. *Community Service DOES NOT INCLUDE babysitting, lawn/gardening service for self or others, employment, pet care, basic household chores or anything that involves compensation. Activity
Example Out of School: Volunteer Soccer Coach Example In School: Haunted High School REBEL Club
Years Participated (9, 10, 11, and/or 12)
Name of Faculty Sponsor
Initial of Faculty Member or Verification Attached
9,10,11
Mr. John Smith
Verification Attached (Include Contact Info)
10,11
Mr. LaPalomento
Mr. LaPalomento’s Initials Here
If more space is needed attach a duplicate page behind this page
PART C: LEADERSHIP Leadership is defined as a manager or organizer who consistently demonstrates ability to lead in the classroom and beyond. Whether it be by example, behind the scenes, or more vocal, there are many ways to be a leader. Though many leadership positions come with a specific title, we understand many do not. With that being said, it is imperative to understand that participating in a club or activity, does not equate to being a leader. You should only ask an advisor or coach for a leadership letter if you are certain that they will attest to the fact that you have demonstrated all the characteristics of a leader. Leadership roles must be verified by the advisor/coach of the organization, club, team or affiliation through a survey that can be found on the NHS page of the school website. One survey is attached to this form, but more surveys are available at www.monroetwp.k12.nj.us/HighSchool/NHS . Please give your advisor/coach at least one week notice. You may include one faculty leadership recommendation as a classroom leader for one year only. Your remaining two or three years must be covered by a leadership role (not necessarily by title) from an organization outside of the classroom. This should be for a role that requires you to be responsible for managing, organizing or leading others on a consistent basis. You must have at least 1 leadership position for each year of enrollment and a survey must be separately filled out for each position (no need for multiple surveys if the same position was held for multiple years). Leadership Position
Example: Leadership Role in The Rock
Years Participated (9, 10, 11, and/or 12) 10
Note: The attached survey should briefly describe how you acted as a leader.
If more space is needed attach a duplicate page behind this page
PART D: CHARACTER Character is defined as the mental and moral qualities of an individual. In essence, your character is WHO YOU ARE and how you are perceived by others. This includes your personality, temperament, disposition and your nature toward others. It is difficult to quantify character so the committee is requiring a written component to the application in order to best assess your character. Please respond to the question below in essay format. The essay needs to be typed, 12 point Times New Roman font, double spaced. There is a rubric as well to help you create the best possible essay to exemplify your character. Essay Topic: In all of world history, there have been a plethora of exemplary leaders. Choose a leader you have learned about in your studies whom you feel is the best role model for you as you pursue a career and work toward personal success. Describe 3-5 ways in which you are similar to this leader and specifically describe the traits you find most desirable in this individual. Your essay will be assessed according to the rubric below: Score
Organization
Spelling, Grammar, Length
Content
Character Justification
1
Essay is unorganized with no clear thesis or supporting statements; typed
Essay contains more than 5 spelling or grammar errors; less than 5 paragraphs
Essay does not clearly identify Writer does not the individual or make focus on character comparisons between the writer in the essay and the individual chosen
2
Essay has a thesis statement and some supporting details; typed
Essay contains 2-4 spelling or grammar errors; less than 5 paragraphs
Essay defines the individual, but does not make comparisons between the writer and the individual chosen
Writer only briefly addresses character in their essay
3
Essay has a clear and developed thesis with 3 or more supporting details; typed
Essay is free of spelling or grammar errors; 5 paragraphs or more
Essay both defines the individual and makes clear comparisons between the writer and the individual chosen
Writer clearly and consistently addresses character in their essay
PART E: HONORS AND AWARDS Honors and awards are defined as any documented honor or award bestowed upon a student for accomplishment in the school or community. Please attach a copy of documentation of any awards which exemplify the applicant’s adherence to the 4 Pillars of NHS. Please only include copies as these materials will not be returned. It is recommended to provide evidence of at least 2 Honors or Awards earned by the applicant. Please do not attach Honor Roll/Principal’s List Honors as those are documented through academic verification and do not count for this category.
PART F: DISCIPLINE Please list ANY and ALL discipline you have received during your high school career. You are required to explain the circumstances behind your discipline. Please know that discipline can harm your chances at admittance into the organization, but failing to report discipline will result in the disqualification of your application. If you have not had any discipline, please rewrite the following statement in the space provided: “I have not received any disciplinary punishment as a student of Williamstown High School.” _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________
PART F: SIGNATURES Please obtain signatures of SIX Williamstown High School teachers who support your admittance into National Honor Society and believe that you exemplify the Four Pillars of our organization. ______________________________________
_____________________________________
______________________________________
_____________________________________
______________________________________
_____________________________________
Part G: Grade Verification Please obtain the signature of your current Guidance Counselor and have them fill out the form below.
Student Name (Write in BEFORE giving to guidance):____________________________________________ Counselor Signature________________________________ Counselor Name: ________________________ Current Weighted GPA: _______________________
Current Unweighted GPA: __________________
PART H: ACCEPTANCE OF TERMS AND CONDITIONS By signing in the space below, the applicant and parent/guardian are agreeing to these terms and conditions below set forth by the Williamstown High School National Honor Society. I. II. III. IV. V. VI. VII. VIII.
IX.
X.
All enclosed information is accurate and verifiable. If information cannot be verified, it will not be considered. It is the applicant’s responsibility to complete the application in its entirety. Parents are asked to review all submissions as well. Any information omitted will not be considered. If any information is found to be invalid, it will result in immediate disqualification of the application. Applications of other applicants will not be shared. Applications are not comparatively assessed, rather assessed according to the standards set forth in this application. Parents/Guardians and applicants are aware that they are assessed based upon their adherence to the Four Pillars of NHS. Exemplary grades are not the basis for our decision. All applications are reviewed by an anonymous committee of faculty members. Their names will not be disclosed. All applications are reviewed anonymously. The applicant’s name is not revealed in the Selection Process. If accepted, the applicant agrees to abide by all terms and requirements of the organization. Membership can be terminated at any time due to failure to adhere to membership guidelines. Applicant agrees to attend all pre-set meetings. Notice will be given via written approval or rejection. Timelines are dependent upon availability of voluntary Selection Committee. In the event of denial, parents agree to request justification for denial via email to the advisor, Mr. Mark LaPalomento, at [email protected]. Late applications will not be considered under any circumstances. All applications are due by 2:20 PM on Thursday, November 17.
Applicant Name (Print): ________________________________________________ Applicant Signature: ____________________________________________________ Parent/Guardian Name (Print): ________________________________________ Parent/Guardian Signature: ____________________________________________ Date of Submission: ___________
Leadership Survey (Used for Part C: Leadership) Thank you for offering to recommend this student to Williamstown High School’s National Honor Society! To recommend this student, please complete this survey and return to the requesting student. If you prefer to write a letter of recommendation, please feel free to do so. Please email Mr. Mark LaPalomento at [email protected] with any questions. Name of Student Applicant: ____________________________________________________________ Name of Referring Teacher/Coach/Other: _________________________________________________ Reference Contact Email (Not needed for WHS Staff)_________________________________________ Leadership Position or Role:____________________________________________________________ ***Application Deadline: Thursday, November 17, 2016*** 1. This student consistently demonstrates strong leadership qualities in my presence. Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
2. Circle all that apply: In what way does this student lead in your organization? Vocal Leader
Leads by example
Leads behind the scenes with planning
Comments: In 1-2 sentences please give a brief explanation of how this student has been a leader in your organization or classroom.
Reference Signature: __________________________________________________ Date: _____________
APPLICATION CHECKLIST Please check off each item below as you complete your application. ⎯ ⎯ ⎯ ⎯ ⎯ ⎯ ⎯ ⎯ ⎯ ⎯ ⎯ ⎯
Cover Sheet is completely filled out At least 2 School Service Activities are listed for EACH YEAR of enrollment at WHS At least 2 Community Service Activities are listed for EACH YEAR of enrollment at WHS Proof for all Community Service Activities not completed at WHS listed are attached One leadership role for EACH YEAR of enrollment at WHS is listed with survey included No more than ONE leadership role is a “Classroom Leader” Character Essay is attached and meets all requirements listed At least 2 Honors/Awards Certificate copies are attached Discipline has been explained or statement has been written in the space provided Signatures have been obtained from all teachers and Guidance Counselor Acceptance of Terms and Conditions has been signed by applicant and parent/guardian All responses are submitted typed or in ink Questions? Email Mr. LaPalomento at [email protected]
Appendices: All documentation including surveys, awards, letters, etc. should be placed at the end of your application in the following order. Appendix A: School Service Documentation o Only provide documentation if the advisor of your club is no longer at this school and was unable to initial your application Appendix B: Community Service Documentation o Documentation is not needed if the service was done as part of a WHS organization and was initialed by the staff member in charge. Appendix C: Leadership Documentation o One survey or letter of recommendation for each leadership role. o A survey or letter is required for every role of leadership, but not needed for each year if that role was maintained multiple years Appendix D: Attach your Typed Essay Appendix E: Attach at least 2 Honors and Award documentation (copies only) *All attachments need to
be submitted in this order, stapled in a manila folder
All applications are due on Thursday, November 17 at 2:20 PM and under no circumstances will an application be accepted late. Collection of applications will begin Monday, November 14 in the main office only.
Applicant Name: _____________________________________________________________ Student ID Number: _________________________ Homeroom Section: ________________ Homeroom Teacher: ___________________________ Homeroom Room Number:________
Please submit all responses typed or in ink Final product should be stapled top left and placed in a manila folder
PART A: SCHOOL SERVICE School service is defined as participation in a school-based organization, club, team or faculty sponsored activity. The organization, club, team or other affiliation must have a current Williamstown High School faculty member as the advisor, coach or sponsor. Applicants are required to demonstrate involvement in at least 2 School Service Activities for each year of enrollment. In order to verify participation, applicants are asked to complete the form below and secure initials from the faculty member charged with that organization, club, team or activity. *School Service DOES NOT INCLUDE Scholastic Academies, curricular-based activities or anything not sponsored by a Williamstown High School faculty or staff member. Activity
Years Participated (9, 10, 11, and/or 12)
Example: Italian American Club
9, 10, 11
Name of Faculty Sponsor
Mr. DiCristofaro
If more space is needed attach a duplicate page behind this page
Initial of Faculty Member
PART B: COMMUNITY SERVICE Community service is defined as participation with a community-based organization. Service constitutes an activity to which you receive no monetary or other gains through your participation. If the service was done with an organization not affiliated with WHS you must attach written documentation of your participation from a verifiable source including contact information (a certificate or letter from the person in charge is best). If the service was done through a school organization (example: worked Haunted High School) you would just need the initials from the teacher in charge of that organization. You must provide proof of at least 2 community service activities for each year of enrollment. Failure to provide proof will result in the activity being omitted from consideration in your application. *Community Service DOES NOT INCLUDE babysitting, lawn/gardening service for self or others, employment, pet care, basic household chores or anything that involves compensation. Activity
Example Out of School: Volunteer Soccer Coach Example In School: Haunted High School REBEL Club
Years Participated (9, 10, 11, and/or 12)
Name of Faculty Sponsor
Initial of Faculty Member or Verification Attached
9,10,11
Mr. John Smith
Verification Attached (Include Contact Info)
10,11
Mr. LaPalomento
Mr. LaPalomento’s Initials Here
If more space is needed attach a duplicate page behind this page
PART C: LEADERSHIP Leadership is defined as a manager or organizer who consistently demonstrates ability to lead in the classroom and beyond. Whether it be by example, behind the scenes, or more vocal, there are many ways to be a leader. Though many leadership positions come with a specific title, we understand many do not. With that being said, it is imperative to understand that participating in a club or activity, does not equate to being a leader. You should only ask an advisor or coach for a leadership letter if you are certain that they will attest to the fact that you have demonstrated all the characteristics of a leader. Leadership roles must be verified by the advisor/coach of the organization, club, team or affiliation through a survey that can be found on the NHS page of the school website. One survey is attached to this form, but more surveys are available at www.monroetwp.k12.nj.us/HighSchool/NHS . Please give your advisor/coach at least one week notice. You may include one faculty leadership recommendation as a classroom leader for one year only. Your remaining two or three years must be covered by a leadership role (not necessarily by title) from an organization outside of the classroom. This should be for a role that requires you to be responsible for managing, organizing or leading others on a consistent basis. You must have at least 1 leadership position for each year of enrollment and a survey must be separately filled out for each position (no need for multiple surveys if the same position was held for multiple years). Leadership Position
Example: Leadership Role in The Rock
Years Participated (9, 10, 11, and/or 12) 10
Note: The attached survey should briefly describe how you acted as a leader.
If more space is needed attach a duplicate page behind this page
PART D: CHARACTER Character is defined as the mental and moral qualities of an individual. In essence, your character is WHO YOU ARE and how you are perceived by others. This includes your personality, temperament, disposition and your nature toward others. It is difficult to quantify character so the committee is requiring a written component to the application in order to best assess your character. Please respond to the question below in essay format. The essay needs to be typed, 12 point Times New Roman font, double spaced. There is a rubric as well to help you create the best possible essay to exemplify your character. Essay Topic: In all of world history, there have been a plethora of exemplary leaders. Choose a leader you have learned about in your studies whom you feel is the best role model for you as you pursue a career and work toward personal success. Describe 3-5 ways in which you are similar to this leader and specifically describe the traits you find most desirable in this individual. Your essay will be assessed according to the rubric below: Score
Organization
Spelling, Grammar, Length
Content
Character Justification
1
Essay is unorganized with no clear thesis or supporting statements; typed
Essay contains more than 5 spelling or grammar errors; less than 5 paragraphs
Essay does not clearly identify Writer does not the individual or make focus on character comparisons between the writer in the essay and the individual chosen
2
Essay has a thesis statement and some supporting details; typed
Essay contains 2-4 spelling or grammar errors; less than 5 paragraphs
Essay defines the individual, but does not make comparisons between the writer and the individual chosen
Writer only briefly addresses character in their essay
3
Essay has a clear and developed thesis with 3 or more supporting details; typed
Essay is free of spelling or grammar errors; 5 paragraphs or more
Essay both defines the individual and makes clear comparisons between the writer and the individual chosen
Writer clearly and consistently addresses character in their essay
PART E: HONORS AND AWARDS Honors and awards are defined as any documented honor or award bestowed upon a student for accomplishment in the school or community. Please attach a copy of documentation of any awards which exemplify the applicant’s adherence to the 4 Pillars of NHS. Please only include copies as these materials will not be returned. It is recommended to provide evidence of at least 2 Honors or Awards earned by the applicant. Please do not attach Honor Roll/Principal’s List Honors as those are documented through academic verification and do not count for this category.
PART F: DISCIPLINE Please list ANY and ALL discipline you have received during your high school career. You are required to explain the circumstances behind your discipline. Please know that discipline can harm your chances at admittance into the organization, but failing to report discipline will result in the disqualification of your application. If you have not had any discipline, please rewrite the following statement in the space provided: “I have not received any disciplinary punishment as a student of Williamstown High School.” _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________
PART F: SIGNATURES Please obtain signatures of SIX Williamstown High School teachers who support your admittance into National Honor Society and believe that you exemplify the Four Pillars of our organization. ______________________________________
_____________________________________
______________________________________
_____________________________________
______________________________________
_____________________________________
Part G: Grade Verification Please obtain the signature of your current Guidance Counselor and have them fill out the form below.
Student Name (Write in BEFORE giving to guidance):____________________________________________ Counselor Signature________________________________ Counselor Name: ________________________ Current Weighted GPA: _______________________
Current Unweighted GPA: __________________
PART H: ACCEPTANCE OF TERMS AND CONDITIONS By signing in the space below, the applicant and parent/guardian are agreeing to these terms and conditions below set forth by the Williamstown High School National Honor Society. I. II. III. IV. V. VI. VII. VIII.
IX.
X.
All enclosed information is accurate and verifiable. If information cannot be verified, it will not be considered. It is the applicant’s responsibility to complete the application in its entirety. Parents are asked to review all submissions as well. Any information omitted will not be considered. If any information is found to be invalid, it will result in immediate disqualification of the application. Applications of other applicants will not be shared. Applications are not comparatively assessed, rather assessed according to the standards set forth in this application. Parents/Guardians and applicants are aware that they are assessed based upon their adherence to the Four Pillars of NHS. Exemplary grades are not the basis for our decision. All applications are reviewed by an anonymous committee of faculty members. Their names will not be disclosed. All applications are reviewed anonymously. The applicant’s name is not revealed in the Selection Process. If accepted, the applicant agrees to abide by all terms and requirements of the organization. Membership can be terminated at any time due to failure to adhere to membership guidelines. Applicant agrees to attend all pre-set meetings. Notice will be given via written approval or rejection. Timelines are dependent upon availability of voluntary Selection Committee. In the event of denial, parents agree to request justification for denial via email to the advisor, Mr. Mark LaPalomento, at [email protected]. Late applications will not be considered under any circumstances. All applications are due by 2:20 PM on Thursday, November 17.
Applicant Name (Print): ________________________________________________ Applicant Signature: ____________________________________________________ Parent/Guardian Name (Print): ________________________________________ Parent/Guardian Signature: ____________________________________________ Date of Submission: ___________
Leadership Survey (Used for Part C: Leadership) Thank you for offering to recommend this student to Williamstown High School’s National Honor Society! To recommend this student, please complete this survey and return to the requesting student. If you prefer to write a letter of recommendation, please feel free to do so. Please email Mr. Mark LaPalomento at [email protected] with any questions. Name of Student Applicant: ____________________________________________________________ Name of Referring Teacher/Coach/Other: _________________________________________________ Reference Contact Email (Not needed for WHS Staff)_________________________________________ Leadership Position or Role:____________________________________________________________ ***Application Deadline: Thursday, November 17, 2016*** 1. This student consistently demonstrates strong leadership qualities in my presence. Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
2. Circle all that apply: In what way does this student lead in your organization? Vocal Leader
Leads by example
Leads behind the scenes with planning
Comments: In 1-2 sentences please give a brief explanation of how this student has been a leader in your organization or classroom.
Reference Signature: __________________________________________________ Date: _____________
APPLICATION CHECKLIST Please check off each item below as you complete your application. ⎯ ⎯ ⎯ ⎯ ⎯ ⎯ ⎯ ⎯ ⎯ ⎯ ⎯ ⎯
Cover Sheet is completely filled out At least 2 School Service Activities are listed for EACH YEAR of enrollment at WHS At least 2 Community Service Activities are listed for EACH YEAR of enrollment at WHS Proof for all Community Service Activities not completed at WHS listed are attached One leadership role for EACH YEAR of enrollment at WHS is listed with survey included No more than ONE leadership role is a “Classroom Leader” Character Essay is attached and meets all requirements listed At least 2 Honors/Awards Certificate copies are attached Discipline has been explained or statement has been written in the space provided Signatures have been obtained from all teachers and Guidance Counselor Acceptance of Terms and Conditions has been signed by applicant and parent/guardian All responses are submitted typed or in ink Questions? Email Mr. LaPalomento at [email protected]
Appendices: All documentation including surveys, awards, letters, etc. should be placed at the end of your application in the following order. Appendix A: School Service Documentation o Only provide documentation if the advisor of your club is no longer at this school and was unable to initial your application Appendix B: Community Service Documentation o Documentation is not needed if the service was done as part of a WHS organization and was initialed by the staff member in charge. Appendix C: Leadership Documentation o One survey or letter of recommendation for each leadership role. o A survey or letter is required for every role of leadership, but not needed for each year if that role was maintained multiple years Appendix D: Attach your Typed Essay Appendix E: Attach at least 2 Honors and Award documentation (copies only) *All attachments need to
be submitted in this order, stapled in a manila folder
