Bethesda-Chevy Chase High School

Lien Le, Advisor

Audrey Hersman, President

Applicant Name: .
Current Grade Level: ............ (10/11)
Hours: ...............

Cumulative GPA: ...............

# of SSL

Homeroom Teacher: ...................................................... Homeroom

Room: .....................................
Home
Address: ..............................................................................................................................
.........
.................................................................................................................
......................
Home Phone: ......................................................... Cell
Phone: .........................................................
Email Address: ..............................................................................

I understand that completing and submitting this application does not guarantee selection to the
National Honor Society. I attest that the information presented here is complete and accurate. If
selected, I agree to abide by the standards and guidelines of the chapter and to fulfill all of my
membership obligations to the best of my ability.
1

Print Name: ...

.
Sign: ...................................................................................
Date: .........................................................

APPLICATION DUE FRIDAY, APRIL 17TH, 2015, 2:30 PM, TO MS. LE IN

B-315
Bethesda-Chevy Chase High School
National Honor Society Application Checklist
(Enclose this checklist with your application)
Applicant Name: .
Enclose
d?
(Y/N)

Page(
s)

Component

Cover Page

Checklist
3 teacher evaluations (list names of teachers below)

35

Each evaluation should be returned in a sealed envelope with the teachers signature or initials
across the seal. YOU WILL BE PROVIDING THESE ENVELOPES TO YOUR TEACHERS. Your
name and the title NHS Teacher Evaluation should be written on the front of each envelope.
These may be submitted directly to Ms. Le.
1.

..............................................................................

2.

..............................................................................

3. ..............................................................................
2 service verifications (list names of organizations or groups below)
67

1.

..............................................................................

2. ..............................................................................
1 leadership verification (list name of organization or group below)
8
1.
9

..............................................................................

1 personal statement

2014 2015 1st Semester Transcript

Once all application materials have been collected, they should be placed in a large manila envelope. The envelope
should be labeled with your name and National Honor Society Application.
All required materials should be turned in together at the time of application. Incomplete applications will not be
reviewed.

APPLICATION DUE FRIDAY, APRIL 17TH, 2015, 2:30 PM, TO MS. LE IN

B-315

Bethesda-Chevy Chase High School

National Honor Society Application Teacher Evaluation
Applicant: Complete the top portion only.
Dear ..............................................................................,
(teacher name)

I am applying for membership in the National Honor Society. As a part of my application, I am required to obtain
teacher evaluations of my character. I value your opinion and would appreciate your assistance in helping me to
complete this part of my application. Please complete this evaluation and place it in the envelope that I have provided
for you. Please place your initials or signature across the seal. My application is due no later than Friday, April 17 th,
2015, so I kindly ask that you submit this evaluation before that date.
Thank you again for your assistance in this process,
..............................................................................
(applicant name)

------------------------------------------------------------------------------------------------To be completed by teacher:

In what course did you teach this applicant and
when? ......................................................................................................................
Check the appropriate box that best describes the character of the applicant.
Very much
like the
applicant

Attribute

Like the
applicant

Unlike the
applicant

Very much
unlike the
applicant

No basis
for
judgment

Shows enthusiasm
Finishes what they start
Invigorates others
Tries hard even after experiencing
setbacks
Cooperation with others
Concern for others
Actively listens to others
Has a sense of humor
Practices open-mindedness
Acts with integrity
Recommendation:

_____

recommend without reservation

_____

recommend with reservation

(Please comment.)
_____

do not recommend (Please comment.)

Comments: .........................................................................................................................................................................
..........................
............................................................................................................................................................................................
............................
............................................................................................................................................................................................
............................ ...............................................................................................................................................................
.........................................................
(continue on back, if necessary)

Signature ..............................................................................

Date .........................................................

DO NOT RETURN TO THE APPLICANT!

Please sign and return Lien Le (mailbox or Room B-315) by Friday, April 17, 2015.
Thank you.

Bethesda-Chevy Chase High School

National Honor Society Application Teacher Evaluation
Applicant: Complete the top portion only.
Dear ..............................................................................,
(teacher name)

I am applying for membership in the National Honor Society. As a part of my application, I am required to obtain
teacher evaluations of my character. I value your opinion and would appreciate your assistance in helping me to
complete this part of my application. Please complete this evaluation and place it in the envelope that I have provided
for you. Please place your initials or signature across the seal. My application is due no later than Friday, April 17 th,
2015, so I kindly ask that you submit this evaluation before that date.
Thank you again for your assistance in this process,
..............................................................................
(applicant name)

------------------------------------------------------------------------------------------------To be completed by teacher:

In what course did you teach this applicant and
when? ......................................................................................................................
Check the appropriate box that best describes the character of the applicant.
Attribute

Very much
like the
applicant

Like the
applicant

Unlike the
applicant

Very much
unlike the
applicant

No basis
for
judgment

Shows enthusiasm
Finishes what they start
Invigorates others
Tries hard even after experiencing
setbacks
Cooperation with others
Concern for others
Actively listens to others
Has a sense of humor
Practices open-mindedness
Acts with integrity

Recommendation:

_____

recommend without reservation

_____

recommend with reservation

(Please comment.)
_____

do not recommend (Please comment.)

Comments: .........................................................................................................................................................................
..........................
............................................................................................................................................................................................
............................
............................................................................................................................................................................................
............................ ...............................................................................................................................................................
.........................................................
(continue on back, if necessary)

Signature ..............................................................................

Date .........................................................

DO NOT RETURN TO THE APPLICANT!

Please sign and return Lien Le (mailbox or Room B-315) by Friday, April 17, 2015.
Thank you.

Bethesda-Chevy Chase High School

National Honor Society Application Teacher Evaluation
Applicant: Complete the top portion only.
Dear ..............................................................................,
(teacher name)

I am applying for membership in the National Honor Society. As a part of my application, I am required to obtain
teacher evaluations of my character. I value your opinion and would appreciate your assistance in helping me to
complete this part of my application. Please complete this evaluation and place it in the envelope that I have provided
for you. Please place your initials or signature across the seal. My application is due no later than Friday, April 17 th,
2015, so I kindly ask that you submit this evaluation before that date.
Thank you again for your assistance in this process,
..............................................................................

(applicant name)

------------------------------------------------------------------------------------------------To be completed by teacher:

In what course did you teach this applicant and
when? ......................................................................................................................
Check the appropriate box that best describes the character of the applicant.
Attribute

Very much
like the
applicant

Like the
applicant

Unlike the
applicant

Very much
unlike the
applicant

No basis
for
judgment

Shows enthusiasm
Finishes what they start
Invigorates others
Tries hard even after experiencing
setbacks
Cooperation with others
Concern for others

Actively listens to others

Has a sense of humor
Practices open-mindedness
Acts with integrity
Recommendation:

_____

recommend without reservation

_____

recommend with reservation

(Please comment.)
_____

do not recommend (Please comment.)

Comments: .........................................................................................................................................................................
..........................
............................................................................................................................................................................................
............................
............................................................................................................................................................................................
............................ ...............................................................................................................................................................
.........................................................
(continue on back, if necessary)

Signature ..............................................................................

Date .........................................................

DO NOT RETURN TO THE APPLICANT!

Please sign and return Lien Le (mailbox or Room B-315) by Friday, April 17, 2015.
Thank you.

Bethesda-Chevy Chase High School

National Honor Society Application Service Verification
Applicant: The verifications you submit should include specific examples of service to our school or
community.
Dear Service Coordinator,
I am applying for membership in the National Honor Society. As a part of my application, I am required to obtain
verifications of my commitment to service. I appreciate your assistance in helping me to complete this part of my
application. Please verify the information that I have completed on this form. My application is due no later than Friday,
April 17th, 2015, so I kindly ask that you return this to me before that date.
Thank you again for your assistance in this process,
..............................................................................
(applicant name)

Organization Name: ......................................................................................................................

Organization Address: .................................................................................................................................................
.................................................................................................................................................
Organization Phone Number or Email: ......................................................................................................................
Specific examples of service that I provided to the above named organization and how it helped the school or
community:
(continue on back if necessary)

Approximate number of hours that I committed to the above named organization:

Timeframe of service: from .................................................................................
to .................................................................................
------------------------------------------------------------------------------------------------To be completed by coordinator:
As a service coordinator for the above noted organization, I confirm that the information that the applicant has
provided on this form is accurate.
Recommendation:

_____

recommend without reservation

_____

recommend with reservation

(Please comment.)
_____

do not recommend (Please comment.)

Comments: .........................................................................................................................................................................
..........................
............................................................................................................................................................................................
............................
............................................................................................................................................................................................
............................ ...............................................................................................................................................................
.........................................................
(continue on back, if necessary)

Name ..............................................................................
Signature ..............................................................................
Title ..............................................................................

Date .........................................................

Bethesda-Chevy Chase High School

National Honor Society Application Service Verification
Applicant: The verifications you submit should include specific examples of service to our school or
community.
Dear Service Coordinator,
I am applying for membership in the National Honor Society. As a part of my application, I am required to obtain
verifications of my commitment to service. I appreciate your assistance in helping me to complete this part of my
application. Please verify the information that I have completed on this form. My application is due no later than Friday,
April 17th, 2015, so I kindly ask that you return this to me before that date.
Thank you again for your assistance in this process,
..............................................................................
(applicant name)

Organization Name: ......................................................................................................................

Organization Address: .................................................................................................................................................
.................................................................................................................................................

Organization Phone Number or Email: ......................................................................................................................

Specific examples of service that I provided to the above named organization and how it helped the school or
community:
(continue on back if necessary)

Approximate number of hours that I committed to the above named organization:

Timeframe of service: from .................................................................................
to .................................................................................
------------------------------------------------------------------------------------------------To be completed by coordinator:
As a service coordinator for the above noted organization, I confirm that the information that the applicant has
provided on this form is accurate.
Recommendation:

_____

recommend without reservation

_____

recommend with reservation

(Please comment.)
_____

do not recommend (Please comment.)

Comments: .........................................................................................................................................................................
..........................
............................................................................................................................................................................................
............................
............................................................................................................................................................................................
............................ ...............................................................................................................................................................
.........................................................
(continue on back, if necessary)

Name ..............................................................................
Signature ..............................................................................
Title ..............................................................................

Date .........................................................

Bethesda-Chevy Chase High School

National Honor Society Application Leadership Verification
Applicant: The verification you submit should include recent (during high school) and specific examples
of leadership at school or in the community and do not require you to be or have been a titled leader in
an organization or group.
Dear Leadership Coordinator,
I am applying for membership in the National Honor Society. As a part of my application, I am required to obtain a
verification of my ability to lead in a role I currently hold or have held recently. I appreciate your assistance in helping

me to complete this part of my application. Please verify the information that I have completed on this form. My
application is due no later than Friday, April 17th, 2015, so I kindly ask that you return this to me before that date.
Thank you again for your assistance in this process,
..............................................................................

(applicant name)

Organization Name: ......................................................................................................................

Organization Address: .................................................................................................................................................
.................................................................................................................................................
Organization Phone Number or Email: ......................................................................................................................
Specific examples of leadership roles that I fulfilled to the above named organization and how it helped the
organization or group meet a common goal: (continue on back if necessary)

Approximate number of hours that I committed to the above named organization:

Timeframe of lead: from .................................................................................
to .................................................................................
------------------------------------------------------------------------------------------------To be completed by coordinator:
As a service coordinator for the above noted organization, I confirm that the information that the applicant has
provided on this form is accurate.
Recommendation:

_____

recommend without reservation

_____

recommend with reservation

(Please comment.)
_____

do not recommend (Please comment.)

Comments: .........................................................................................................................................................................
..........................
............................................................................................................................................................................................
............................
............................................................................................................................................................................................
............................ ...............................................................................................................................................................
.........................................................
(continue on back, if necessary)

Name ..............................................................................
Signature ..............................................................................
Title ..............................................................................

Date .........................................................

Bethesda-Chevy Chase High School

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National Honor Society Application Personal Statement

Respond to the prompt in 250 500 words:
The National Honor Society is a group of student leaders who achieve academically, commit their time to serving the
community, and embody a strong and positive character. Students in NHS are expected to be the future leaders of
society. Who is a leader (historical, fictional, or in your life) that you admire? Describe the character traits
that this person embodies that make them a good leader and why they inspire you to become a better
leader.

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