National Honor Society Application Page 3

Pascack Hills High School Chapter of the National Honor Society

Application Cover Sheet

I understand that completion of this form does not guarantee selection, that falsification of information on this form

will lead to disqualification from candidacy, and that every entry requires an appropriate signature.

Student Signature:___________________________________________________ Date:________________

Student Name:______________________________________________________

Student Address:____________________________________________________

Home Phone Number: ____________________________________

I have read the information provided by my daughter/son on this form and can verify that it is true, accurate, and

complete in its presentation.

Parent/Guardian Signature: ____________________________________________ Date:_________________

Parent Guardian Name:________________________________________________

Work Phone Number: ___________________________

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