Breckinridge County CHAPTER OF THE NATIONAL HONOR SOCIETY Student Activity Information Form (NOT AN APPLICATION FORM) Directions:

Please complete all sections. Dont be modest. Every bit of information can be used by the faculty council to assist with the selection process, Type all the sections and print out to get signatures. Handwritten applications will not be accepted. Completion of this form does not guarantee selection. ADMINISTRATIVE INFORMATION

Other information as required: COCURRICULAR ACTIVITES: List all the activities in which you have participated in during high school. Include clubs, teams, musical group, etc. and major accomplishments in each year. Grade 9 10 11 12

High School Activities Art/Music Clubs Summer Jam Committee Concert/Marching Band Gifted and Talented/Visual Arts YAPA (Young Americans for Political Action) The Student Y Club

Accomplishments Homecoming Float Designs, Summer Jam Committee. Organization of Local Concert for Youth. Upperclassman Instructor, Competitions, Fundraising. WKU Trips, In/Out-of-school Participation. Political Debates, Current Events. KYA (Kentucky Youth Association), Service Hours.

COMMUNITY ACTIVITIES: List all the community activities in which you have participated. Note any major accomplishments in each. These should be any activities outside of school in which you participate for betterment of the community. For example: church groups, clubs sponsored outside of school, philanthropic activities, volunteer groups, or community art endeavors. Grade High School Activities 9 10 11 12 Accomplishments Bethel Church Youth Performing for local Band youth, Acting as a Role Model to newcomers. SJC Hospitality Setting Up Food for Bands Performing at Summer Jam, Organizing Fundraisers. Logo/ Graphics Designer Designing for Local Bands and Businesses Salvation Army Accumulating Service Hours Through Various Acts (Ex. Bell Ringing) Landscape and Design Topiary Management for the School and Local Businesses During Class Time USBC Youth (United Leadership Activities, States Bowling State Tournaments Conference) No. of hours/work About 4 hours each week About 20 hours a week, once a year Varies 2-3 service hours Varies Signature of Adult Sponsor

Varies

LEADERSHIP POSITIONS: 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. For example: elected student body class or club officer, committee chairperson, team captain, newspaper editor, work area manager, or community leader. Grade 9 10 11 12

Leadership Position Upperclassman Role Model/Director Designer/ Band Manager

Activity or Organization Concert/Marching Band The Crisis of Dying, A Local Band

RECOGNITION OR AWARD: List any honors or recognition that you have received which support you bid to be selected for membership in National Honor Society. Grade 9 10 11 12

Recognition or Reward Honor Roll Perfect Attendance Award

Group or Activity School School

JOB EXPERIENCES: List below any work experience, either paid or volunteer, which you feel supports your bid to the National Honor Society. Numbers of hours/weeks Spent on job/volunteer About 4 hours a week

Job Landscape Design (Helping in the Greenhouse) McDaniels Auto Sales (Home Business) Cashiering, Filing Paperwork, Car Maintenance, Etc. Summer Jam Concert (Helping to set up, Advertise and Collect Donations)

9 10 11 12

About 12 hours a week

About 20 hours a week, once a year