ÐÏà¡±á>þÿ :<þÿÿÿ9ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿì¥Á ð¿%bjbj$¯$¯ 4FÅ«gFÅ«gÿÿÿÿÿÿ·ÂÂTTTTTÿÿÿÿhhh8 $ÄhÛ*pàààààiiiZ*\*\*\*\*\*\*$K-¶0®€*Ti^iii€*TTàà+•*;;;iFTàTàZ*;iZ*;;Ž"(h^)àÿÿÿÿðOÂY˜n×ÿÿÿÿ¯RŠ(F*«*0Û*š(Ä¯0$¯0 ^)¯0T^)èii;iiiii€*€*%iiiÛ*iiiiÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ¯0iiiiiiiiiÂX: CENTRAL BUCKS SOUTH NATIONAL HONOR SOCIETY IN-SCHOOL ACTIVITY EVALUATION FORM (make copies as needed for section I) TO BE COMPLETED BY APPLICANT: Name of Student: _________________________________________ Activity: _________________________________________________ Participated: ( 10th ( 11th Anticipated to participate: ( 12th TO BE COMPLETED BY ADVISOR/COACH/COORDINATOR OF ACTIVITY: Advisor/Coordinator of Activity: ___________________________________________ (please print) Advisor’s signature: ( ______________________________________ Advisor’s Email Address: _______________________________________________ Advisor’s Phone Number: ________________________ Please rank the above student in the following categories (1 being lowest and 5 being highest): Commitment ( 1 ( 2 ( 3 ( 4 ( 5 Ability to work with others ( 1 ( 2 ( 3 ( 4 ( 5 Integrity ( 1 ( 2 ( 3 ( 4 ( 5 Are there any requirements of your activity that could be considered community service hours: ( YES ( NO If you selected YES, please explain the requirements: _____________________________________________________________________________________________ _____________________________________________________________________________________________ Is the above student: An appointed/elected leader ( YES ( NO If you selected YES: Who appointed/elected: What is the position: _________________________________ Advisor/Coach Peers If elected/appointed for the upcoming school year did the above student do any work thus far towards his/her position: ( YES ( NO After completion, this form should be placed in a sealed envelope (provided by the student), SIGNED OVER THE SEAL, and returned to the student. 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