BISMARCK PUBLIC SCHOOLS NATIONAL HONOR SOCIETY COMMUNITY SERVICE LOG Illegible hours or hours without signatures will not be accepted. It is highly recommended that students record all hours served. Also, please note that parents cannot serve as supervisors and sign for students’ volunteerism. Printed full legal name

Student ID number

Student email address

Name of organization

List all of the exact dates of involvement (mm/dd/yy)

Supervisor’s name (Please Print)

Supervisor’s phone number

Supervisor must answer the following questions:

Supervisor’s signature

YES NO The student completed the service with a positive, courteous, enthusiastic spirit. YES NO This benefitted a non-profit/charity. YES NO This student was required to do this as a part of a class, court order, or extra-curricular activity.

Name of organization

List all of the exact dates of involvement (mm/dd/yy)

Supervisor’s name (Please Print)

Supervisor’s phone number

Supervisor must answer the following questions:

YES NO The student completed the service with a positive, courteous, enthusiastic spirit. YES NO This benefitted a non-profit/charity. YES NO This student was required to do this as a part of a class, court order, or extra-curricular activity. List all of the exact dates of involvement (mm/dd/yy)

Supervisor’s name (Please Print)

Supervisor’s phone number

YES NO The student completed the service with a positive, courteous, enthusiastic spirit. YES NO This benefitted a non-profit/charity. YES NO This student was required to do this as a part of a class, court order, or extra-curricular activity. List all of the exact dates of involvement (mm/dd/yy)

Supervisor’s name (Please Print)

Supervisor’s phone number

YES NO The student completed the service with a positive, courteous, enthusiastic spirit. YES NO This benefitted a non-profit/charity. YES NO This student was required to do this as a part of a class, court order, or extra-curricular activity. List all of the exact dates of involvement (mm/dd/yy)

Supervisor’s name (Please Print)

Supervisor’s phone number

Total Hours

Supervisor’s signature

YES NO The student completed the service with a positive, courteous, enthusiastic spirit. YES NO This benefitted a non-profit/charity. YES NO This student was required to do this as a part of a class, court order, or extra-curricular activity.

Name of organization

List all of the exact dates of involvement (mm/dd/yy)

Supervisor’s name (Please Print)

Supervisor’s phone number

Supervisor must answer the following questions:

Total Hours

Supervisor’s signature

Name of organization

Supervisor must answer the following questions:

Total Hours

Supervisor’s signature

Name of organization

Supervisor must answer the following questions:

Total Hours

Supervisor’s signature

Name of organization

Supervisor must answer the following questions:

Grade

Total Hours

Supervisor’s signature

YES NO The student completed the service with a positive, courteous, enthusiastic spirit. YES NO This benefitted a non-profit/charity. YES NO This student was required to do this as a part of a class, court order, or extra-curricular activity. TOTAL HOURS (Calculations must be accurate or else this form will not be considered.)

Total Hours

NATIONAL HONOR SOCIETY SIGNATURE VERIFICATION FORM STUDENT MEMBERSHIP National Honor Society (NHS) is more than just an honor roll. Each Honor Society chapter establishes rules for membership that are based upon a student's outstanding performance in Scholarship, Service, Leadership, and Character. Scholarship Students who have a cumulative grade point average of 3.5 (on a 4.0 scale) meet the scholarship requirement for membership. Service This quality is defined through the voluntary contributions made by a student to the school or community, done without compensation and with a positive, courteous, and enthusiastic spirit. Leadership Student leaders are those who are resourceful, good problem solvers, promoters of school activities, ideacontributors, dependable, and persons who exemplify positive attitudes about life. Leadership experiences can be drawn from school or community activities while working with or for others. Character The student of good character upholds principles of morality and ethics, is cooperative, demonstrates high standards of honesty and reliability, shows courtesy, concern, and respect for others, and generally maintains a good and clean lifestyle.

My signature below indicates that  I understand that my submission does not guarantee membership, but indicates that I am being considered for membership in the National Honor Society.  I accept the decision by the National Honor Society Faculty Council as final.  If accepted, I will uphold the National Honor Society standards as described above for Scholarship, Service, Leadership, and Character. Failure to do so could result in the termination of my membership.  I am aware of and subscribe to the local chapter National Honor Society bylaws as listed on the BPS NHS website.  I verify that all of the information that I submit on the Induction Candidate Form and this form is true and correct.

________________________________ _________________________________ ___________________ Student Name (Printed) Student Signature Date NATIONAL HONOR SOCIETY PARENT/GUARDIAN SIGNATURE VERIFICATION I do hereby give my consent that any and all written records created, used, or maintained by the school in connection with the process of selection of candidates to become members of the Bismarck Public Schools (BHS and CHS) National Honor Society shall remain confidential from my child and myself, and I hereby waive any and all rights that I may have under any statute, ordinance or law to gain access to or copies of such records or materials. I also understand that my child’s submission does not guarantee membership, but indicates that he or she is being considered for membership.

________________________________ _________________________________ ___________________ Parent Name (Printed) Parent Signature Date

*Taken from the Official Site of the National Honor Society and the National Junior Honor Society. “Student Membership.” http://www.nhs.us.

BPS Log and Signature Verification Form 2015-2016.pdf ...

Service, Leadership, and Character. Failure to do so could result in the termination of my membership. I am aware of and subscribe to the local chapter ...

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