NTHS VERIFICATION AND PAYMENT FORM FOR DEBAKEY HSHP STUDENTS
This form and payment will not be accepted if the student has not completed the online application by the posted deadline.
Reminder: Do submit this form unless you meet the requirement of overall 3.25 GPA or higher, 150 documented
community service hours, and is a paid member of HOSA, BPA or BETA, and no office “P” or “U”.
HST Teacher _________________________ Period ________ HOSA/BPA/BETA Advisor ____________________________
Last Name____________________________ First Name ___________________________ Middle ____________________
Home Phone: ________________ Students Cell Phone ______ _________ Grade Level ____ T-shirt Size ______
PERIOD
HR
Tutorial
1A
2A
3A
4A
5 (1B)
6 (2B)
7 (3B)
8 (4B)
SUBJECT
ROOM
INSTRUCTOR
REMARKS OR CHANGES
Return this completed NTHS Verification form to Ms. Jackson in Room 332 along with cash or money order made out to DeBakey
HSHP in the amount of $30.00 (US) by the due date listed on the NTHS bulletin board, unless otherwise instructed.
NTHS Active Member Participation Agreement
DeBakey’ NTHS Mission is to honor student achievement and leadership, promote educational excellence, award scholarships, and enhance
career opportunities. The Vision is to be the international leader in providing recognition for excellence in career and technical education. This
is a participation agreement between the HOSA advisors at DeBakey High School for Health Professions and the HOSA Student listed on this
application, and we mutually agree to the following terms and conditions:
To receive graduation regalia such as an honor cord, certificate, wallet card, diploma seal, and be recommended for the various NTHS
scholarships, students must strive to be an active member in NTHS by participating in the following events both junior and senior year.

Pay membership dues and submit application by the required due date.

Compete at the local level in HOSA, BPA, or BETA club

Participate in the fundraiser for HOSA, BPA, or BETA club

Participate in the community service projects (CSP) for HOSA, BPA, or BETA club

Attend NTHS meetings (1st Tuesday each Month) and your scheduled HOSA, BPA, or BETA club meetings.

Register yourself at 1st NTHS meeting: Info needed: Secondary student, full time, Graduation date, and HTSC code ________ (See
NTHS board)
The HOSA, BPA, or BETA club sponsors will sign documents stating that students meet their requirements prior to graduation. Students that do
not meet the requirements will be NTHS members in name only.
I have read the participation agreement above and agree to abide by its terms and conditions.
____________________________________________________________________________
NTHS Parent’s Signature
____________________________________________________________________________
NTHS Student’s Signature
____________
Date
____________
Date
NTHS Student’s Printed Name ___________________________________________________
Verification for Active Membership:
This section will be completed by Mrs. Jackson each year.
Fall CSP
Fall Fundraiser
Spring CSP
Spring Fundraiser
Description of
Project
Jackson Verification
NTHS is committed to the elimination of discrimination based upon age, gender, race, class economic
status, ethnic background, physical ability, and religious or cultural considerations.