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									                               National Honor Society
                             Milton High School Chapter
                          Student Activity Information Form

        Congratulations on being invited to submit this packet of information for
consideration in the National Honor Society. As you may already know, the National
Honor Society is the most prestigious academic society in our country. While it is an
honor that you are being invited to submit an information packet for consideration in the
Society, please know that if selected, you will also have the obligation to be an active
member. This includes participating in our fundraising and charitable activities and
being available if needed to tutor a student from our community. While completion of
this form does not guarantee selection in the Society, your receiving it demonstrates the
high academic achievement you have attained at Milton High School.
        Please read all directions carefully and complete all sections. Do not be modest,
but please be honest. Every piece of information will be considered by the faculty during
the selection process. All information on this form must be typed or you may re-create
the form on your own word-processing system if you wish. Please use care if re-creating
this format on your own system. Leave nothing out. Any proofreading or typographical
errors could seriously compromise your candidacy. Please make six copies of the
completed packet, including the letter described below. Please make the copies after you
have had your coaches and club advisors initialed the original form. All materials you
submit must be neat and professional and hand delivered to Mr. Cooper in room 107
no later than Wednesday, March 19, 2008, at 2:30.
        In addition, for all activities in which you participated during high school,
including clubs, teams, musical groups, etc. you must get the advisors or coaches to
sign off that you were an active participant in those activities. If that person is no
longer on the staff, please have the present advisor or coach sign off instead. Any
community service hours that you submit must be registered with the Guidance office
and your guidance counselor must sign off for those hours. No community service
hours will be taken into consideration unless Guidance has approved them. As
noted in the Student Handbook, a minimum of one-hundred hours of community service
is required for selection into the Society. In addition, present and past teachers will be
welcomed to offer input as to the strength of your character and leadership.
        Finally, you must also write a letter, no longer than one page, double spaced in a
standard 12 point font, with one inch margins, in which you go into greater depth
regarding your activities and accomplishments and express how these experiences have
impacted on your life. This should also help the faculty to assess the outstanding nature
of your character. You must have your parent or guardian sign as to the truth and
accuracy of your information and letter.
        If you have any questions regarding this procedure, please feel free to leave a note
in Mr. Cooper’s mailbox in the main office or come to his office, room 107.
                                      National Honor Society
                                     Milton High School Chapter
                                  Student Activity Information Form

I.     Administrative Information:

       Name: Diana Fidrocki____________________         Phone: 617-696-2736_______________
       Period I Teacher’s Name: Mr. Bertrand_________ Room #:_138________________________

II.    Extra-Curricular Activities:

       List all activities in which you have been an active participant during high school. Include clubs,
       teams, musical groups, student government, Boy and Girl Scouts, etc. and major accomplishments
       and awards. Please remember to list each grade year in which you participated and have all your
       advisors and coaches sign off for each activity. If your coach is not at Milton High School, have
       Mr. Traister sign off for them. Please feel free to add more lines if you need them on a separate
       sheet of paper.

       ACTIVITY                    GRADE(S)          ACCOMPLISHMENTS                      STAFF SIGN OFF

       MHS Spring Track______9-12___________Varsity Grade 9______________________________

       MHS Indoor Track______9-12___________Varsity Grade 10_____________________________

       Band/Flute____________9-12___________Wind Ensemble Grade 11______________________

       Pep Band______________9-12_____________________________________________________

       Commonwealth Figure Skating Club 9-12__3rd at State Games of America__________________

       Key Club______________9-12_____________________________________________________

III.   Leadership:

       List examples of leadership that you have exercised in school, church, community, or work
       activities. Understand that leadership may also include activities where you taught or motivated
       others, provided a positive role model, effectively participated in co-curricular activities, or held a
       formal office or position in a group or team. The examples that you list must be specific and show
       that you were responsible for directing or motivating others. (For example, Organized Bake Sale,
       9th Grade, French Club)

       LEADERSHIP ACTIVITY                           GRADE(S)                     ORGANIZATION

       Commonwealth Learn to Skate___________9-12__________Commonwealth Figure Skating Club

       Milton Youth Hockey Learn to Skate______9-12_______________Milton Youth Hockey

       Japanese Exchange_____________________10________________Milton High School________

       Choreographer Basics Show Number              11        ______Commonwealth Figure Skating Club

IV.      Community Service Activities:

         List community activities in which you have participated and note any major accomplishments in
         each. These should be any activities outside of the school day in which you participated for the
         betterment of your community. For example: church groups, clubs sponsored outside the school,
         Boy or Girl Scouts, volunteer groups, or community art and music endeavors, recycling club,
         Homework Club help, etc.

         COMMUNITY ACTIVITY                  YEAR         # OF HOURS             ACCOMPLISHMENT

         Pep Band________________________’05-‘07_____15 hours___________________________

         Commonwealth Learn to Skate_______’05-‘08_____46 hours_____________________________

         Milton Youth Hockey Learn to Skate___’05-‘08_____95 hours____________________________

         Japanese Exchange_________________’06_________10 hours____________________________

         Key Club Thanksgiving Meal at Unquity House_’05-‘07__20 hours________________________

         Key Club Celebrate Milton Table______’07_________10 hours___________________________



         Guidance Councilor Sign Off:______________________________________________________

Please complete this Information Form and letter, make six copies of your completed information packet,
staple the pages of each packet together, with the first page of the information form on the top, your letter
on the bottom, and hand all seven copies of all material directly and personally to me in my classroom
(room 107) not later than the date stated in the cover letter. Meeting this deadline will take a serious
commitment. Information packets will NOT be accepted after the deadline. You may attach a separate
sheet of paper to include any additional information. You should expect a decision on your candidacy to be
made within four weeks.

         Mr. Aidan T. Cooper
         Faculty Advisor
         National Honor Society
         Milton High School Chapter

I give permission for the Faculty Advisory board to review my discipline record to aid in the determination
of my character. All information indicated in this information packet, including the letter, is true and
accurate. I have not misrepresented myself in any way.

___________________________________________________                     ______________________
Student Signature                                                       Date

___________________________________________________                     _______________________
Parent Signature                                                        Date

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