ࡱ> 685? 3bjbjԠԠ 4"hh3   ,$ !#@ NP Cjf0n,s$Efs$s$fs$ X b: CENTRAL BUCKS SOUTH NATIONAL HONOR SOCIETY LEADERSHIP EVALUATION FORM (make copies as needed for section II) APPLICANTS NAME : _______________________________________  TO BE COMPLETED BY THE ADULT SUPERVISOR: We are considering a member of your activity for induction into the National Honor Society. For the purpose of examining their leadership role, the student should have requested that you fill out this form confirming his/her position. Please completely fill out all the blanks and check off only the criteria that applies to the above applicant. We also ask that if you have a business card or other supporting documentation for your organization to please attach it to this form. If the directions are not followed, the students acceptance into National Honor Society is at jeopardy. Name: ___________________________________ Position: _______________________________ Relationship to Student (be specific): _______________________________________________________ Email Address: ___________________________________ Phone Number: (____)_______________ Leadership title or role in which student participated for your organization: _____________________________________________________________________________________ Length of time student was in a leadership role (only count since the start of 10th grade):________________________________________________________________________ Start date: _______________ End date: ______________ Please check here if still ongoing ( Role was: ( Appointed by adult(s) ( Elected by peers ( Student applied for position Tangible examples of how student displayed leadership: _______________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ( Applicant was responsible for teaching, coordinating, directing, and/or managing others (not just assisting someone) ( Applicant planned or created a lesson/activity/project and implemented it (not just assisting someone) ( Leadership position was not affiliated with family or friends. ( Applicant was committed (on time for activity and displayed appropriate dress and behavior) ( Applicant was hardworking (did the job that was required) ( Applicant was a positive role model to others Additional Comments: __________________________________________________________________ _____________________________________________________________________________________  Adult Supervisors signature: (_________________________________ Date: _____________ Please attach your business card or some other type of supporting documentation for your organization to this form and place in a sealed envelope (provided to you by the student), sign over the seal, and return to the student. 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