Universal​ ​School

Extracurricular​ ​Activities​ ​Form

Information​ ​requested​ ​is​ ​needed​ ​for​ ​academic​ ​transcripts.​ ​Please​ ​make​ ​sure​ ​all​ ​the​ ​information​ ​is​ ​accurate.
Please​ ​print:
First​ ​name: Middle​ ​Initial: Last​ ​name:
Address: City:​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​,​ ​Illinois Zip​ ​Code:
Year​ ​of​ ​graduation:​ ​2020 Date​ ​of​ ​birth:​ ​ ​ ​ ​ ​ ​ ​ ​ ​/​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​/ Soc.​ ​Sec.​ ​#​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​-​ ​ ​ ​ ​ ​ ​ ​ ​ ​-
Parent/Guardian​ ​name: ​ ​ACT​ ​: SAT:

CLUB OFFICE/POSITION/TITLE ADVISOR/COACH CONTACT​ ​INFO CHECK​ ​IF

PARTICIPANT
ID​ ​Club​ ​(Shelter,​ ​Food​ ​Pantry,
Interfaith​ ​Events)
Students​ ​for​ ​Humanitarian​ ​Aide

National​ ​Honor​ ​Society

Book​ ​Club

Student​ ​Council

I.T.​ ​Squad

Cancer​ ​Awareness​ ​Club

Drama​ ​Club

H-UNIT​ ​(School​ ​Spirit)

STEM​ ​Club

MUNUC​ ​(Model​ ​United​ ​Nations​ ​of

the​ ​University​ ​of​ ​Chicago)
Debka​ ​Troupe

VOLUNTEER​ ​WORK

Mosque​ ​Foundation

CIOGC​ ​(Council​ ​of​ ​Islamic

Organization​ ​of​ ​Greater​ ​Chicago)
Mosque​ ​Foundation​ ​Community
Center
Local​ ​Public​ ​Library
(Provide​ ​Name)
Palos​ ​Community​ ​Hospital

Christ​ ​Hospital

Zakat​ ​Foundation

AMP​ ​(American​ ​Muslims​ ​for

Palestine)
Universal​ ​Saturday​ ​School
Program
Sunday​ ​School​ ​Program
MAS-ICNA​ ​(Muslim​ ​American
Society-Islamic​ ​Society​ ​of​ ​North
America)
Sound​ ​Vision​ ​Events

Tutoring​ ​(Other​ ​than​ ​NHS

member)
Universal​ ​All​ ​School​ ​Program
(Other​ ​than​ ​NHS​ ​member)
Universal​ ​School​ ​Fun​ ​Fair
(Other​ ​than​ ​NHS​ ​member)

SPORTS

Basketball

Soccer

Wrestling

Baseball

Volleyball

Chess

COMPETITION

Lexicon

Quran

Arabic​ ​Spelling​ ​Bee

Mathletes

MIST​ ​(Muslim​ ​Interscholastic

Tournament)
WYSE​ ​(World​ ​Youth​ ​Science​ ​&
Engineering)
Regional​ ​Science​ ​Fair

State​ ​Science​ ​Fair

Islamic​ ​Knowledge​ ​Bowl

AWARDS ADD​ ​ONLY TOP​ ​3​ ​PLACES Where Appropriate

NO​ ​NEED​ ​TO​ ​ADD PARTICIPATION AWARDS
Honor​ ​Roll

High​ ​Honor​ ​Roll

School​ ​Science​ ​Fair

Regional​ ​Science​ ​Fair

State​ ​Science​ ​Fair

WYSE

Arabic​ ​Spelling​ ​Bee

Quran

Islamic​ ​Knowledge

MVP​ ​(Indicate​ ​Sport)

Athletics

Exemplary​ ​Behavior

OTHER

IMAD​ ​(Illinois​ ​Muslim​ ​Action

Day)
MYLS​ ​(Muslim​ ​Youth​ ​Leadership
Symposium)
International​ ​Fest

Election​ ​Judge

IMPORTANT​ ​NOTE:
1. Abbreviations​ ​and​ ​Acronyms​ ​must​ ​be​ ​spelled​ ​out
2. Form​ ​must​ ​be​ ​filled​ ​out​ ​in​ ​BLUE​ ​or​ ​BLACK​ ​INK​ ​PEN
3. DO​ ​NOT​ ​submit​ ​form​ ​without​ ​SIGNATURES​ ​&​ ​CONTACT​ ​INFO​ ​or​ ​otherwise​ ​INCOMPLETE
4. MUST​ ​SUBMIT​ ​BY​ ​DEADLINE​ ​INDICATED​ ​ABOVE
5. For​ ​AWARDS​ ​Category,​ ​ONLY​ ​include​ ​SIGNIFICANT​ ​ones.​ ​Do​ ​NOT​ ​add​ ​PARTICIPATION​ ​Awards