For official use only, Packet No. _______
Pride of Mountain Pointe Chapter National Honor Society Student Information Packet Name:________Zane Hassinan_________________________________________ (please type) Student Number:_____________________s18500475___________________ VERIFICATION I verify the accuracy of all the information I provide in this document.
I understand that providing misleading or false information will prevent me from being further considered for membership this year and can also result in having my membership immediately revoked should I become an active member.
Student Signature:_______________________________________
Date:_______10/5/2017______________________
I approve of my student's application for consideration for National Honor Society membership.
-Parent Signature:_______________________________________
Parent's Typed Name:________Debra Hassinan___________________________
Date:_____________________________
For official use only Packet No. _______ II. B. Character List up to five co-curricular activities in which you have participated during high school. Please prioritize your activities so that the most important to you is the first you list. Include clubs, teams, musical groups, etc. , and major accomplishments in each. You may include school-related and non-school activities Do not list leadership or service accomplishments here! Remember that incomplete information may result in your packet not being favorably considered for membership this year.
Activity
Years participated
Total hours per year
Name of Verifier
Phone & Email
Verifier Signature
Mphs Boys Soccer Team
9 10 11 12
100+
Club Soccer
9 10 11 12
300+
Mphs Football Team
10 11 12
150+
Kokopelli
10 11 12
300+
Mphs Physics Club
12
25
Please describe below how one of these activities has helped to shape facets of your character that exemplify integrity, ethics or self-discipline. Have an adult who can verify this statement sign below your statement. Unsigned entries will prevent you from being further considered for membership this year.
Being on the Mountain Pointe soccer team has helped me through my years of high school to grow and shape me into a better person every year.
__________________________________________________
_____________________________________________
_________________________________
Confirming Adult Signature
Printed Name
Position
(______)___________________________ and/or email _________________________________________ Daytime phone number Special Comments Section:
For official use only Packet No. _______ III. Leadership List up to five elected or appointed leadership positions held in school, community or work activities. Please prioritize your activities so that the most important to you is the first you list. Only those positions in which you were directly responsible for directing or motivating others should be includ...
