Roberto Clemente
National Junior Honor Society
Application Packet Cover Page
***This Application Packet is due no later than Wednesday April 6, 2016***
(Hand in a hard copy to Ms. Brodsky Rm. #144 or
Ms. Zahavi Rm. #143. We will check that you have
included all parts of your application)
Please assemble your packet in the following order. Make sure your name is on every
page! Staple in the upper left hand corner.
□ Application Packet Cover Page
□ Student Activity Information Sheet
□ Character Statement
□ Teacher Recommendation Form
I understand that completion of this packet does not guarantee selection into the
National Junior Honor Society and I verify that all information presented is both
accurate and complete.
Student Name (first & last; please print) Grade
Student Signature
Date
Name of Candidate:
Grade:_
_
National Junior Honor Society
Student Activity Information Sheet
Directions:
• Please complete all sections of this sheet
• Please print clearly or type (you can download this form off the RCMS website if you would like
to type your answers)
• Brag about yourself, don’t be modest!
• If you have more items than space provided, please list only the most important. You can use
your essay portion for details and other accomplishments that you would also like to share.
1. Scholarship
Cumulative GPA from 2nd Quarter Report Card ____________
2. Leadership Activities
Neatly List all leadership roles within the classroom and effective participation in positions of
responsibility in other activities offered on campus such as athletic team captains, section leaders in
band and chorus, committee chairs in student groups.
Activity
Ex. Recycling Club
Accomplishments
Made posters & collected recycling
weekly
Year
6th Grade
Name of Candidate:
Grade:_
3. Service
Neatly list all service activities in which you have participated in the last two years. These can be
service projects with a group in or out of school or done as an individual. Generally, these are done
for or on the behalf of others (not including immediate family) for no compensation (payment). Please
include the name and contact information of an adult who can verify your service activities.
Service Activity, Organization,
and Location
Ex. Collected and distributed
coats at Agape Homeless Shelter,
Silver Spring
Dates/# of
hours
November, 5
hours;
December 5
hours
Contact
Person
Joe Smith
Contact Phone Number
or Email
[email protected]
4. Character
Number of office referrals ____________*
*If you have two or more office referrals, please respond to the following statement on a separate
piece of paper.
Give a detailed justification that explains how you know you are capable of the following:







Consistently exemplifying positive and desirable qualities of behavior
Cooperating by complying with school policies and regulations and codes of student conduct
Taking criticism willingly and accepting recommendations graciously
Demonstrating the highest standards of honesty, academic integrity, and reliability
Regularly exhibiting courtesy, concern, and respect for others
Complying with instructions and rules
Displaying personal responsibility.
National Junior Honor Society
Character Statement (Paragraph)
Give a detailed statement that supports at least one character trait that you embody that
reflects one of the following: leadership, service, citizenship, or scholarship.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Name of Candidate:
Grade:
National Junior Honor Society
Teacher Recommendation Form
This student is eligible for membership in the National Junior Honor Society (NJHS). Students must
obtain four teacher signatures, three of which must be from current or last year’s core (English,
Reading, Math, World Studies, or Science) teachers, and one from a current or past elective
teacher. Students, please be considerate by requesting recommendations at a convenient time.
Selection for membership is determined by the Faculty Council and is based on outstanding
scholarship (3.0 cumulative GPA), citizenship, character, leadership, and service. Once
selected, members have the responsibility to continue to demonstrate these qualities.
If you would recommend the candidate, according to the above stated qualifications- without
reservation, please sign in the space below.
1. I recommend this candidate, without reservation, for membership in the NJHS.
Teacher Signature
Print Name
Current or last year’s Core Subject Taught
2. I recommend this candidate, without reservation, for membership in the NJHS.
Teacher Signature
Print Name
Current or last year’s Core Subject Taught
3. I recommend this candidate, without reservation, for membership in the NJHS.
Teacher Signature
Print Name
Current or last year’s Core Subject Taught
4. I recommend this candidate, without reservation, for membership in the NJHS.
Teacher Signature
Current or past Elective Subject Taught
Print Name
Candidate Evaluation Rubric (for Faculty Council Use Only)
Student Name ________________________________________
Scholarship
Service
Character
Date
4
GPA of 4.0
4
The candidate list more
than two community
service activities
4
3
GPA of 3.75 to 3.9
3
The candidate lists at
least two community
service activities
3
2
GPA of 3.5 to 3.74
2
The candidate lists at
least one community
service activity
2
1
GPA of 3.0 to 3.4
1
Has no community service
experience listed
No Referrals &
No Referrals &
1 Referral &
More than 1 referrals &
The candidate gives a
detailed statement that
supports at least one
character trait that
embodies: leadership,
service, citizenship, or
scholarship.
The candidate gives a
sufficient statement that
supports at least one
character trait that
embodies: leadership,
service, citizenship, or
scholarship.
The candidate gives a
sufficient statement that
supports at least one
character trait that
embodies: leadership,
service, citizenship, or
scholarship.
The candidate gives a
sufficient statement that
supports at least one
character trait that embodies:
leadership, service,
citizenship, or scholarship.
1
AND
The candidate gives a
detailed justification that
explains how they know and
are capable of the following:
Consistently exemplifies
positive and desirable
qualities of behavior,
Cooperates by complying
with school policies and
regulations and codes of
student conduct ,Takes
criticism willingly and
accepts recommendations
graciously, demonstrates the
highest standards of honesty,
academic, integrity, and
reliability, regularly exhibits
courtesy, concern, and respect
for others, complies with
instructions and rules, and
displays personal responsibility.
Leadership
Staff
Recommendations
4
The candidate list more
than two community
service activities
4
3
The candidate lists at
least two community
service activities
3
2
The candidate lists at
least one community
service activity
2
1
Has no community service
experience listed
Has 4 teacher
recommendations
Has 3 teacher
recommendations
Has 2 teacher
recommendations
Has 1 or less teacher
recommendations
1