M O N T G O M E R Y C O U N T Y P U B L I C S C H O O L S

NATIONAL HONOR SOCIETY MONTGOMERY BLAIR HIGH SCHOOL CHAPTER

APPLICATION FORM

Name: Junior/Senior:

Address:

Email Address (PRINT):

GPA (cumulative 3.3): SSL Hours: Deadline/Due: September 29, 2017

1. Service Hour Requirement (at least 120 SSL hours) List major service projects.

Organization Year Accomplishments

9 10 11 12

sd

2. Co-curricular Activities List activities, clubs, and teams you have participated in high school.

Activity Year Accomplishments

9 10 11 12

3. Two (2) Letter of Recommendations (Academic, Leadership) Forms attached.

1. _________________________________________ Position: ____________________________

2. _________________________________________ Position: ____________________________

4. Leadership Positions

Organization Year Accomplishments

9 10 11 12

The information I have provided is, to the best of my knowledge, accurate and complete. I have

read the selection procedures and agree to fulfill the responsibilities of membership in the

Montgomery Blair Chapter of the National Honor Society.

______________________________ ______________________________

Candidate's Signature Parent's Signature

M O N T G O M E R Y C O U N T Y P U B L I C S C H O O L S

NATIONAL HONOR SOCIETY MONTGOMERY BLAIR HIGH SCHOOL CHAPTER

CHECKLIST

_______ I have verified that I have a minimum of a 3.3 cumulative grade point average.

_______ I have included and verified at least 120 hours of community service.

_______ I have completely listed all of my activities in at least three Montgomery Blair High School

clubs or activities on the attached activities.

_______ I have included two letters of recommendation. The hard copy is attached in a sealed envelope

or emailed to Mr. Tung Pham at Tung_T_Pham@mcpsmd.org.

_______ I understand that meeting the minimum requirement does not guarantee acceptance into NHS.

ACTIVITIES OF NATIONAL HONOR SOCIETY:

1. Perform a service project or projects of at least 20 hours each year.

2. Attend all NHS meetings unless excused by advisor, participate in mandatory service project, and

participate in the induction ceremony.

I HAVE READ THE APPLICATION PROCESS AND UNDERSTAND THAT SIGNING THIS

DOCUMENT, I ACCEPT THE APPLICATION PROCESS. I understand that meeting the

minimum requirement does not guarantee acceptance to NHS.

___________________________________

Applicant’s Signature

___________________________________

Parent’s Signature (indicate I have read

the above information)

___________________________________

Date

PLEASE RETURN THIS SIGNED FORM WITH YOUR COMPLETED APPLICATION NO

LATER THAN September 29, 2017.

M O N T G O M E R Y C O U N T Y P U B L I C S C H O O L S

NATIONAL HONOR SOCIETY MONTGOMERY BLAIR HIGH SCHOOL CHAPTER

LETTER OF RECOMMENDATION #1

Please complete this form and return to the student in an envelope. Please be sure to sign

over the seal of the envelope. You may attach a supplementary document or letter. Please

may also return this letter to Mr. Tung Pham in Room 238 or in his mailbox in the main

office by Friday September 29, 2017.

Student Name (Please Print): ________________________________ ID: __________________

Reference Name (Please Print): ______________________________ Position: ________________

Course(s) taught: ______________________________ Year: 9th grade | 10th grade | 11th grade

Please check the appropriate box. Excellent Average Below

Average

No Basis

Leadership

Character

Integrity

Responsibility

Motivation

Class Participation

Willingness to help others

How strongly do you recommend

this student for admission into the

Montgomery Blair chapter of the

National Honor Society?

Highly

Recommend

Recommend Recommend

with

Reservation

DO NOT

Recommend

Additional Comments:

_____________________________________ _______________

Signature Date

M O N T G O M E R Y C O U N T Y P U B L I C S C H O O L S

NATIONAL HONOR SOCIETY MONTGOMERY BLAIR HIGH SCHOOL CHAPTER

LETTER OF RECOMMENDATION #2

Please complete this form and return to the student in an envelope. Please be sure to sign

over the seal of the envelope. You may attach a supplementary document or letter. Please

may also return this letter to Mr. Tung Pham in Room 238 or in his mailbox in the main

office by Friday, September 29, 2017.

Student Name (Please Print): ________________________________ ID: __________________

Reference Name (Please Print): ______________________________ Position: ________________

Please check the appropriate box. Excellent Average Below

Average

No Basis

Leadership

Character

Integrity

Responsibility

Motivation

Class Participation

Willingness to help others

How strongly do you recommend

this student for admission into the

Montgomery Blair chapter of the

National Honor Society?

Highly

Recommend

Recommend Recommend

with

Reservation

DO NOT

Recommend

Additional Comments:

_____________________________________ _______________

Signature Date