Submit to Ms. Sparks, or the office by April 19, 2017
Form available on NJHS Knights in
Service materials page: Download and
enter information electronically
(preferred) or download as pdf. Please
check formatting before completing.
Request for Consideration Form
Lake Travis Middle School
National Junior Honor Society
Full Name:
Perferred Name on Certificate/Program/Announced:
Parent/Guardian Name:
Parent email:
Parent phone number:
Have you received a referral this year? Yes
NO
If yes, please explain in the space provided.
Have you been assigned ISS this year? Yes
If yes, please explain in the space provided.
NO
Submit to Ms. Sparks, or the office by April 19, 2017
Service: “The best way to find yourself is to lose yourself in the service of others.”
― Mahatma Gandhi
List any service you have done from this summer to the present.
Date
Organization
Activity
Hours
Supervisor or Parent
Signature
Add an additional sheet for service to the back of this form if necessary.
Character: “Character is like a tree and reputation its shadow. The shadow is what we
think it is and the tree is the real thing.” ― Abraham Lincoln
In the space provided, how have you demonstrated good character such as honesty,
responsibility, accountability, and/or fairness? Think of examples inside and outside of class.
Your response should be between 100 – 150 words.
Submit to Ms. Sparks, or the office by April 19, 2017
Leadership: “Our chief want is someone who will inspire us to be what we know we
could be.” ― Ralph Waldo Emerson
Describe situations where you have taken on a leadership role such as student council,
church/synagogue groups, team captains, scouts, the classroom, etc. Explain how you have
been involved and what you have learned from these experiences. Your response should
be between 100 – 150 words.
Citizenship: “You are a citizen, and citizenship carries responsibilities.” ― Paul Collier
We have civic responsibilities at the local, state, and national level. Good citizens must
protect the freedoms and rights that have been granted to us and prevent injustice from
entering our lives. A student who demonstrates citizenship understands the importance of
community involvement and has a high regard for freedom, justice, and democracy. How
have you demonstrated a high standard of citizenship? Your response may include
participation and responsibility through involvement with such activities as scouting,
community organizations, and school clubs. Your response should be between 100 – 150
words.
Submit to Ms. Sparks, or the office by April 19, 2017
Citizenship (Continued)
How will you contribute to the LTMS chapter of NJHS? Your response should be between
100 – 150 words.
Submit to Ms. Sparks, or the office by April 19, 2017
(Optional) Is there anything else you want to share about yourself to the Faculty
Committee? Your response should be between 100 – 150 words.
Incomplete forms, forms completed incorrectly, or forms received after the stated due date
will not be considered.
Form available on NJHS Knights in Service Schoology page: Download Word document
and enter information electronically (preferred) or handwrite onto pdf. Please check
formatting before completing. Word documents will not maintain their text features when
opened from an Apple device.
Submit electronically to Ms. Sparks or in person to Ms. Sparks, or the office by April 19,
2017.