PRHS National Honor Society Student Application Packet
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Palmer Ridge High School National Honor Society 2016-2017 Application Packet
Congratulations on your eligibility for consideration for membership for the Palmer Ridge High School
Chapter of the National Honor Society (NHS)! Please read carefully the detailed information below
about the NHS and the application requirements. If you choose to apply for membership consideration
for NHS, the completed application packet is due to Mrs. Cumsille in Neighborhood B no later than
3:15 on Friday, September 9th, 2016.
About National Honor Society
National Honor Society is an organization designed to develop a spirit of community among academically
motivated high school students. Members participate in activities designed to benefit their school and
community. Members are selected based on outstanding performance in the areas of scholarship, service,
leadership, and character.
Palmer Ridge High School NHS Mission Statement
The purpose of this organization is to create enthusiasm for scholarship, to stimulate a desire to render
meaningful service, to promote leadership, and to develop character among NHS members and the Palmer
Ridge High School community.
Palmer Ridge High School NHS Selection Process
Students interested in consideration for selection must submit the attached application packet, thoroughly
completed, to Mrs. Cumsille in Neighborhood B no later than 3:15 p.m., Friday, September 9th.
Once the application deadline has ended, the five-member NHS Faculty Advisory Council, appointed by
the principal, will review applications and select NHS 2015-2016 Inductees. The NHS sponsors are not
members of the Faculty Advisory Council and therefore have no selection privileges. Notification of
acceptance or rejection will be provided by mail. Those individuals accepted will be invited to an
Induction Ceremony on October 5th, 2015 at 7 p.m. Students selected for membership do not become
members of NHS until they have been inducted at the ceremony. The NHS will meet 1st and 3rd Thursdays
at 7am in the Sunset room throughout the school year. The next opportunity after Fall of 2016 for
membership will occur the following fall in 2017.
The Application Packet
Please type all portions of the application. If you are not able to type the application, use blue or black
ink and print legibly. The packet is due in its entirety, except for the four teacher recommendations which
will be turned in directly by recommending teachers to Mrs. Cumsille by the due date. At least two of the
teacher recommendations must be from a core subject teacher—English, Math, Science, Social Studies, or
World Language. The student’s section of the packet is due to Mrs. Cumsille by the due date. Since the
Leadership, Activity, and Service forms must be completed by the sponsor of the activity, applicants
should obtain sponsor statements and signatures as soon as possible.
Due Date/Questions
The completed application packet is due no later than 3:15 p.m., Friday, September 9th, 2016 to
Mrs. Cumsille in Neighborhood B. In fairness to all applicants and because of the Faculty Advisory
Council’s schedule for reviewing the applications, THIS DEADLINE IS FIRM. If you have questions, please
contact Mrs. Cumsille in Neighborhood B or by email: [email protected].
.
PRHS National Honor Society Student Application Packet
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National Honor Society Resume
Student Portion Due to Mrs. Cumsille by 3:15 September 9th, 2016
Name: _______________________________________________________________________
Last First Middle Initial
Home Phone Number: _____________________ Email: _______________________
Please fill out the following based on high school years only.
List the classes you are taking in school year 2016-2017:
_____________________________________________________________________________
List the classes you took in school years 2014-2015 and 2015-2016:
______________________________________________________________________________
______________________________________________________________________________
List activities (clubs, teams, musical groups, etc.) in school and activities in your community in
which you have participated while a high school student. Please list the number of years you
have participated in the activity and any leadership position you have held. You must have one
documented activity and one documented position of elected, auditioned, or selected leadership
position signed by your sponsor, group leader, etc.
Activity Number of years Leadership Positions
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
PRHS National Honor Society Student Application Packet
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List community service activities (soup kitchen, Key Club, Boy Scouts, etc.) in which you have
participated. Please list the number of years that you have participated in each service activity.
Again, you are required to have one documented service activity signed by the sponsor of the
activity.
Service Year[s] Role
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
List awards you have received (athletic awards, academic achievement, school letter, Scouts,
community recognition, etc.):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
List any job experience you have:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
PRHS National Honor Society Student Application Packet
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Please write all of your answers within the space provided. Do not attach additional pages.
How will you manage NHS obligations with your schedule and activities?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
How will you enhance the Palmer Ridge community as a member of NHS?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Please list the names of teachers who will be providing your recommendations:
______________________________ ______________________________
______________________________ ______________________________
Detach the teacher recommendation forms and sponsor documentation forms, submit to
the appropriate teachers/sponsors for completion and return to Mrs. Cumsille. Your
portion of the packet must include all of the forms EXCEPT the teacher recommendations
to be considered for membership. Ask your teachers to return their forms directly to Mrs.
Cumsille by September 9th, 2016.
PRHS National Honor Society Student Application Packet
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Character Recommendation #1
To be completed by a core subject teacher (English, Math, Soc. St., Science, World Lang.)
Teacher: Return directly to Mrs. Cumsille by Friday, Sept. 9, 2016.
Student’s Name: _____________________________ Date you received this form:________
Teacher Name and Subject Taught: ______________________________________________
This form will be used to evaluate the student’s character in the NHS selection process. Thank you for
your assistance! Please rate the student in the following areas by circling the appropriate number—1 is
the lowest and 5 is the highest. Please provide comments for each score so to better enable the Faculty
Advisory Council in its selection of members.
1=Below Average 2=Average 3=Good 4=Very Good, well above average 5=Outstanding, top 5%
1. Takes criticism willingly and accepts recommendations graciously.
1 2 3 4 5
Comments: ___________________________________________________________________________
2. Consistently exemplifies desirable qualities of behavior (positive attitude, friendliness, poise,
tolerance, stability).
1 2 3 4 5
Comments: ___________________________________________________________________________
3. Upholds principles of morality and ethics.
1 2 3 4 5
Comments: ___________________________________________________________________________
4. Cooperates by complying with school regulations concerning property, behavior, dress, etc.
1 2 3 4 5
Comments: ___________________________________________________________________________
5. Demonstrates the highest standards of honesty and reliability.
1 2 3 4 5
Comments: ___________________________________________________________________________
6. Shows courtesy, concern, and respect for others.
1 2 3 4 5
Comments: ___________________________________________________________________________
7. Manifests truthfulness in acknowledging obedience to rules, avoids cheating in written work,
and shows unwillingness to profit by the mistakes of others.
1 2 3 4 5
Comments: ___________________________________________________________________________
8. Demonstrates appropriate maturity.
1 2 3 4 5
Comments: ___________________________________________________________________________
Teacher’s Signature: _________________________________________________________________
Confidential!!
PRHS National Honor Society Student Application Packet
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Character Recommendation #2
To be completed by a core subject teacher (English, Math, Soc. St., Science, World Lang.)
Teacher: Return directly to Mrs. Cumsille by Friday, Sept. 9, 2016.
Student’s Name: _____________________________ Date you received this form:________
Teacher Name and Subject Taught: ______________________________________________
This form will be used to evaluate the student’s character in the NHS selection process. Thank you for
your assistance! Please rate the student in the following areas by circling the appropriate number—1 is
the lowest and 5 is the highest. Please provide comments for each score so to better enable the Faculty
Advisory Council in its selection of members.
1=Below Average 2=Average 3=Good 4=Very Good, well above average 5=Outstanding, top 5%
1. Takes criticism willingly and accepts recommendations graciously.
1 2 3 4 5
Comments: ___________________________________________________________________________
2. Consistently exemplifies desirable qualities of behavior (positive attitude, friendliness, poise,
tolerance, stability).
1 2 3 4 5
Comments: ___________________________________________________________________________
3. Upholds principles of morality and ethics.
1 2 3 4 5
Comments: ___________________________________________________________________________
4. Cooperates by complying with school regulations concerning property, behavior, dress, etc.
1 2 3 4 5
Comments: ___________________________________________________________________________
5. Demonstrates the highest standards of honesty and reliability.
1 2 3 4 5
Comments: ___________________________________________________________________________
6. Shows courtesy, concern, and respect for others.
1 2 3 4 5
Comments: ___________________________________________________________________________
7. Manifests truthfulness in acknowledging obedience to rules, avoids cheating in written work,
and shows unwillingness to profit by the mistakes of others.
1 2 3 4 5
Comments: ___________________________________________________________________________
8. Demonstrates appropriate maturity.
1 2 3 4 5
Comments: ___________________________________________________________________________
Teacher’s Signature: _________________________________________________________________
PRHS National Honor Society Student Application Packet
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Character Recommendation #3
To be completed by any PRHS teacher of the applicant
Teacher: Return directly to Mrs. Cumsille by Friday, Sept. 9, 2016.
Student’s Name: _____________________________ Date you received this form:________
Teacher Name and Subject Taught: ______________________________________________
This form will be used to evaluate the student’s character in the National Honor Society
selection process. Thank you for your assistance! Please rate the student in the following areas by
circling the appropriate number—1 is the lowest and 5 is the highest. Please provide comments for each
score so to better enable the Faculty Advisory Council in its selection of members.
1=Below Average 2=Average 3=Good 4=Very Good, well above average 5=Outstanding, top 5%
1. Takes criticism willingly and accepts recommendations graciously.
1 2 3 4 5
Comments: ___________________________________________________________________________
2. Consistently exemplifies desirable qualities of behavior (positive attitude, friendliness, poise,
tolerance, stability).
1 2 3 4 5
Comments: ___________________________________________________________________________
3. Upholds principles of morality and ethics.
1 2 3 4 5
Comments: ___________________________________________________________________________
4. Cooperates by complying with school regulations concerning property, behavior, dress, etc.
1 2 3 4 5
Comments: ___________________________________________________________________________
5. Demonstrates the highest standards of honesty and reliability.
1 2 3 4 5
Comments: ___________________________________________________________________________
6. Shows courtesy, concern, and respect for others.
1 2 3 4 5
Comments: ___________________________________________________________________________
7. Manifests truthfulness in acknowledging obedience to rules, avoids cheating in written work,
and shows unwillingness to profit by the mistakes of others.
1 2 3 4 5
Comments: ___________________________________________________________________________
8. Demonstrates appropriate maturity.
1 2 3 4 5
Comments: ___________________________________________________________________________
Teacher’s Signature: _________________________________________________________________
Confidential!!
PRHS National Honor Society Student Application Packet
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Character Recommendation #4
To be completed by any PRHS teacher of the applicant
Teacher: Return directly to Mrs. Cumsille by Friday, Sept. 9, 2016.
Student’s Name: _____________________________ Date you received this form:________
Teacher Name and Subject Taught: ______________________________________________
This form will be used to evaluate the student’s character in the National Honor Society
selection process. Thank you for your assistance! Please rate the student in the following areas by
circling the appropriate number—1 is the lowest and 5 is the highest. Please provide comments for each
score so to better enable the Faculty Advisory Council in its selection of members.
1=Below Average 2=Average 3=Good 4=Very Good, well above average 5=Outstanding, top 5%
1. Takes criticism willingly and accepts recommendations graciously.
1 2 3 4 5
Comments: ___________________________________________________________________________
2. Consistently exemplifies desirable qualities of behavior (positive attitude, friendliness, poise,
tolerance, stability).
1 2 3 4 5
Comments: ___________________________________________________________________________
3. Upholds principles of morality and ethics.
1 2 3 4 5
Comments: ___________________________________________________________________________
4. Cooperates by complying with school regulations concerning property, behavior, dress, etc.
1 2 3 4 5
Comments: ___________________________________________________________________________
5. Demonstrates the highest standards of honesty and reliability.
1 2 3 4 5
Comments: ___________________________________________________________________________
6. Shows courtesy, concern, and respect for others.
1 2 3 4 5
Comments: ___________________________________________________________________________
7. Manifests truthfulness in acknowledging obedience to rules, avoids cheating in written work,
and shows unwillingness to profit by the mistakes of others.
1 2 3 4 5
Comments: ___________________________________________________________________________
8. Demonstrates appropriate maturity.
1 2 3 4 5
Comments: ___________________________________________________________________________
Teacher’s Signature: _________________________________________________________________
Confidential!!
PRHS National Honor Society Student Application Packet
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Co-Curricular or Community Activity Documentation
Due by 3:15 September 9, 2016.
Student: Please fill out this form completely and accurately. Next, ask the sponsor (an adult of
no family relation) of the activity to read over the document and sign, verifying the information.
If your sponsor would like to write a comment regarding your participation in the activity, he/she
may do so. This form should be returned to you and included in your application packet.
Student’s Name: __________________________ Date you received form: ____________
Name and description of co-curricular or community activity:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Sponsor’s name and relationship with students (teacher-student, coach-player, etc.):
______________________________________________________________________________
______________________________________________________________________________
Length of time of participation, in weeks: _____________________ weeks
Number of hours spent per week participating in the activity: ___________ hours per week
To the best of your knowledge, the NHS candidate named above has completed the above activity
truthfully and accurately.
Sponsor’s signature: _______________________________________________________
Sponsor’s phone number:________________________ Email:_____________________
Comments/additions:____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Sponsor: You may also contact the Palmer Ridge High School NHS Head Advisor directly
Kait Cumsille, [email protected], 719-867-8104.
PRHS National Honor Society Student Application Packet
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Community Service Documentation
Due by 3:15 September 9, 2016
Student: Please fill out this form completely and accurately. Next, ask the community service
coordinator/someone (an adult of no family relation) receiving the community service to read
over the document and sign, verifying the information. If your sponsor would like to write a
comment regarding your participation in the activity, he/she may do so. This form should be
returned to you and included in your application packet.
Student’s Name: __________________________ Date you received form: ____________
Name and description of community service activity:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Sponsor’s name and relationship with students (teacher-student, coach-player, etc.):
______________________________________________________________________________
_________________________________________________________________________
Length of time of participation, in weeks: _____________________ weeks
Number of hours spent per week participating in the activity: ___________ hours per week
To the best of your knowledge, the NHS candidate named above has completed the above activity
truthfully and accurately.
Sponsor’s signature: _______________________________________________________
Sponsor’s phone number:_________________________ Email: ____________________
Comments/additions:____________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Sponsor: You may also contact the Palmer Ridge High School NHS Head Advisor directly
Kait Cumsille, [email protected], 719-867-8104.
PRHS National Honor Society Student Application Packet
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Leadership Documentation
Due by 3:15 September 9, 2016
Student: List all elected or appointed leadership positions held in school, community, or work
activities; only those positions in which you were directly responsible for directing or motivating
others should be included. Examples are: elected student body representative, class or club
officer, committee chairperson, team captain, newspaper editor, work area manager or
community leader, etc. Teaching Sunday school, babysitting, and other work for which you are
paid are not considered leadership positions. Please fill out this form completely and accurately.
Next, ask the sponsor (an adult of no family relation) of the activity to read over the document
and sign, verifying the information. If your sponsor would like to write a comment regarding
your participation in the activity, he/she may do so. This form should be returned to you and
included in your application packet.
Student’s Name: __________________________ Date you received form: ____________
Name and description of leadership activity:__________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Sponsor’s name and relationship with students (teacher-student, coach-player, etc.):
______________________________________________________________________________
______________________________________________________________________________
Length of time of participation, in weeks: _____________________ weeks
Number of hours spent per week participating in the activity: ___________ hours per week
To the best of your knowledge, the NHS candidate named above has completed the above activity
truthfully and accurately.
Sponsor’s signature: _______________________________________________________
Sponsor’s phone number: _____________________ Email:_______________________
Comments/additions:____________________________________________________________
_____________________________________________________________________________
Sponsor: You may also contact the Palmer Ridge High School NHS Head Advisor directly
Kait Cumsille, [email protected], 719-867-8104.
PRHS National Honor Society Student Application Packet
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National Honor Society
Waiver of Rights
I, the undersigned, acknowledge that by submitting this application I willingly waive any right
for myself or my legal guardian(s) to see, review or scrutinize any/all information regarding my
acceptance or rejection to Palmer Ridge High School’s chapter of the National Honor Society. If
rejected, I understand that I may petition, if I meet the standards of eligibility, to join NHS in one
year’s time.
I acknowledge this application and its contents were submitted with honesty and integrity to the
best of my knowledge and I understand that any false information stated in my application may
lead to my immediate dismissal, if accepted, to NHS.
___________________________________ ___________________________________
Student Signature Parent/Guardian Signature
___________________________
Date
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