Stafford NJHS Candidate Questionnaire

To be considered for membership in the Stafford National Junior Honor Society, this questionnaire must be
completed and returned to Ms. Paliwoda NO LATER THAN February 28th, 2020. Late forms will not be accepted.

Directions: Please complete all sections. Type or print all information and submit it by the published
deadline. Do not be modest. All information will be used by the Faculty Council to assist with the fair
consideration of your candidacy during the selection process. Completion of this form does not
guarantee selection. Should you have questions about this form, please contact Ms. Paliwoda at
paliwodac@friscoisd.org or come to B107.

I. Student Information

___________________________________________________________________________________
Last Name First Name Grade Level

II. Leadership Positions

List all elected or appointed leadership positions held in school, community, or work activities. Only those
positions in which you were responsible for directing or motivating others should be included.
Examples: elected officer for the student body, class, or club; committee chairperson; team captain;
newspaper editor; work area manager; or other community leader. Please include the name of the adult
responsible for supervising your leadership in each position.

Organization/Activity Grade Level Leadership Position Name of Sponsor

(6, 7, 8)
III. Service Activities

List service activities in which you have participated. These can be individual or group service projects
done either in or out of school. Generally speaking, service activities are those that are done for or on
behalf of others (not including immediate family members) for which no compensation (monetary or
other) has been given.

Grade Level
Organization Name Activity Adult Sponsor Name
(6, 7, 8)

IV. Other Student Activities or Community Activities

List all other school-based activities (not noted above) in which you have participated in school. Include
clubs, teams, musical groups, etc., and any significant accomplishments in each.

List other community activities in which you have participated and note any major accomplishment in
each. These should be any activities outside of school in which you participated for the betterment of
your community. For example: religious groups, clubs sponsored outside of the school, Boy or Girl
Scouts, community art endeavors, etc. Do not repeat participation already listed above. Please include
the name of the adult supervisor in each activity.

Grade Level
Organization Name Activity Adult Sponsor Name
(6, 7, 8)
V. Work Experience, Recognition, and Awards

Though not a specific criterion for membership, please list below any job experiences, honors, or
recognition that you have received that support your candidacy for membership in the Honor Society.
Work experience may be paid or volunteer.

Grade Level
Description Adult Sponsor Name
(6, 7, 8)

VI. Essay

Write a paragraph about why you want to join NJHS and what you think you can learn from being a
member. Explain why Leadership, Citizenship, Community Service, Character, and Service are important
in Middle and High School. You may also type and attach your letter.

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________
IX. Teacher Recommendations

Provide the attached Teacher Recommendation forms to two teachers of your choice. The teacher will fill
out the form and submit it directly to the Sponsor. As you have no control over whether the actual
form was returned by the teacher, list the teachers’ names below that received the form from you and the
Sponsor will follow-up if not received.

Teacher #1 _________________________

Teacher #2 _________________________

VI. Signatures

I understand that completing this form does not guarantee selection to the 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.

I understand that to retain my membership in NJHS, I must meet the following ongoing requirements:

● Complete 4 community service hours each grading period of the school year. Form must be
turned in at the end of each grading period by the deadline to count towards completion.
● Achieve a 94.0 grade average for each grading period in all subjects. This is calculated by adding
6 points to each Honors, GT, or PAP class average (not to exceed 100), adding all class grades
together, and dividing by 7. The total average is not rounded up and must be at least 94.0
● Achieve a minimum of an 80 in each core subject (History, ILA, Math, and Science). Six points are
added to each Honors, GT, or PAP prior to consideration.
● Citizenship must include an “S” or “E” in every class on report cards.
● No multiple short-term ISS, all-day ISS, and/or OSS occurrences.
● Attend mandatory meetings and provide annual dues (not to exceed $50.00)

I understand that not meeting any one of these requirements in a grading period will result in a one
grading period probation. Two probations within the school year will result in the dismissal of NJHS. I
also understand that I can withdraw from NJHS at any time by providing a letter to the Sponsor.

Student Signature: __________________________________ Date: ________________

I have read the information provided by my son/daughter on this form and can verify that it is true,
accurate, and complete.

Parent/Guardian Signature: ___________________________ Date: ________________

Return completed form to Ms. Paliwoda in B107 or to my mailbox no later than February 28, 2020.
Responsibility is an important part of being an NJHS Member, so remember:
FORMS RETURNED AFTER THIS DATE CANNOT BE CONSIDERED FOR MEMBERSHIP.