NCCA National Junior Honor Society Candidate Information Form * Required
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1 NCCA National Junior Honor Society Candidate Information Form * Required 1. Grade Level * What is your current grade level at NCCA? Mark only one oval Overall Grade Average * Candidacy is contingent upon having a minimum 90% overall grade average. Based on your Connexus grade book, what is your overall grade average at this time? Be sure that the dropdown menu reads, " " and not just "active". 3. First * What is your first name? 4. Last * What is your last name? NCCA NJHS Candidate Leadership Roles List all elected or appointed leadership positions or other positions of responsibility held in school, community, or work activities. Only those positions in which you were responsible for directing or motivating others should be included (e.g., elected officer for the student body, class, or club; committee chairperson; team captain; newspaper editor; or other community leader). Please include the name of the adult responsible for supervising your leadership in each position. 5. Leadership Role #1 1/8
2 6. Activity/Organization #1 7. Supervising Adult #1 8. Leadership Role #2 9. Activity/Organization #2 10. Supervising Adult #2 NCCA NHJS Candidate Service Activies List service activities in which you have participated. These can be individual or group service projects done either in or out of school. Generally, service activities are those that are done for or on behalf of others (not including immediate family members) for which no compensation (monetary or otherwise) has been given. Please include at least 10 hours of service. 11. Description of Service Activity #1 * 12. Grade When Completed #1 * 13. Hours of Service Completed #1 * 14. Supervising Adult #1 2/8
3 15. Description of Service Activity #2 * 16. Grade When Completed #2 * 17. Hours of Service Completed #2 * 18. Supervising Adult #2 19. Description of Service Activity #3 * 20. Grade When Completed #3 * 21. Hours of Service Completed #3 * 22. Supervising Adult #3 NCCA NJHS Other Candidate Activites 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. 3/8
4 23. Activity Description (#1) 24. Grade Level (#1) Please enter the grade level you were in during the time you participated in this activity. 25. Accomplishments (#1) 26. Activity Description (#2) 27. Grade Level (#2) Please enter the grade level you were in during the time you participated in this activity. 28. Accomplishments (#2) 4/8
5 29. Activity #3 Description 30. Grade Level (#3) Please enter the grade level you were in during the time you participated in this activity. 31. Accomplishments (#3) Other Community Activities 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 (e.g., religious groups, clubs sponsored outside 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 of each activity. 32. Grade Level(s) (#1) 33. Hours (#1) 5/8
6 34. Accomplishments (#1) 35. Supervising Adult (#1) 36. Grade Level(s) (#2) 37. Hours (#2) 38. Accomplishments (#2) 39. Supervising Adult (#2) 40. Grade Level(s) (#3) 41. Hours (#3) 6/8
7 42. Accomplishments (#3) 43. Supervising Adult (#3) NCCA NJHS Candidate Recognition & Awards Though not a specific criterion for membership, please list below any honors, or recognition that you have received that support your candidacy for membership in the National Junior Honor Society. 44. Recognition or Award (#1) 45. Grade Level (#1) 46. Group or Activity (#1) 47. Hours Spent on Activity (if applicable) (#1) 48. Supervising Adult (#1) 49. Recognition or Award (#2) 50. Grade Level (#2) 51. Group or Activity (#2) 7/8
8 52. Hours Spent on Activity (if applicable) (#2) 53. Supervising Adult (#2) 54. Recognition or Award (#3) 55. Grade Level (#3) 56. Group or Activity (#3) 57. Hours Spent on Activity (if applicable) (#3) 58. Supervising Adult (#3) NCCA NJHS Candidate/Caretaker Acknowledgements I understand that completing and submitting this form does not guarantee selection to the National Junior 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. 59. Candidate First & Last 60. Caretaker First & Last 8/8
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