“MEDAL OF HONOR” APPLICATION

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“MEDAL OF HONOR” APPLICATION
LLLou
Smart’s Mill Middle School
850 North King Street
Leesburg, VA 20176
“MEDAL OF HONOR” APPLICATION
During the year, students have been recognized by teachers and staff through the
Cornerstone Awards, Character Counts program, and the honor roll. The Medal of
Honor award recognizes those students who are well rounded and who have set
high standards in many areas at Smart’s Mill during the current school year. Any
sixth, seventh, or eighth grader may apply provided he or she meets the eligibility
requirements listed below and turns in the complete application to the Smart’s Mill
main office by Friday, May 25th.
Eligibility Requirements (all must have occurred during the 2011-2012 school year)
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Earn the A/B honor roll (or higher) two or more times
Participate in two or more Smart’s Mill clubs or after-school activities
Volunteer at least six hours to any community or school group
Submit a one-two page “Smart’s Mill Personal Reflection” This reflection
should describe your personal goals for the year, how you have grown and
matured as a citizen and learner, your goals for the next academic year, and
how Smart’s Mill has helped you attain these goals. Reflection must meet
ALL of the criteria, be legible, and edited for correct grammar and
punctuation.
Verify excellent attendance (No more than 5 absences and/or tardies).
Absences/Tardies for illness or emergencies will not be calculated.
Zero discipline infractions for the school year.
Four teacher/staff recommendations
Turn in complete application packet by May 25, 2012
All Medal of Honor recipients will be notified by May 31, 2012
Phone: (571)-252-2030
www.loudoun.k12.va.us/schools/smarts
LLLou
Smart’s Mill Middle School
850 North King Street
Leesburg, VA 20176
Medal of Honor Application
Cover Page
Student Name: _______________________________________________
Parent Name(s): ______________________________________________
Address: _________________________________________________
Home Phone: ________________________________________________
Attach a copy of your third quarter Report Card
Smart’s Mill clubs/activities (name and sponsor signature):
________________ / _________________
________________ / _________________
Community Volunteerism (name of organization, sponsor signature, and hours):
________________ / _________________/________________
Attach your one-two page “Smart’s Mill Personal Reflection”
Attendance (submit total number):
Absences:____________________________
Tardy to school:________________________
Discipline infractions: (Yes/No)
List the four Smart’s Mill teachers/staff to whom you gave your recommendation:
1.___________________________ 2.___________________________
3.___________________________ 4.___________________________
The above information is correct: Parent Signature ______________________
Student Signature _____________________
Phone: (571)-252-2030
www.loudoun.k12.va.us/schools/smarts
LLLou
Smart’s Mill Middle School
850 North King Street
Leesburg, VA 20176
Teacher/Staff Recommendation Form
Student Name: ______________________________________________
Student – You must copy this form and give it to four teachers or staff in our
building by May 23, 2012 or sooner.
Dear Teacher/Staff - I am applying for the Smart’s Mill Medal of Honor Award.
Please complete this teacher recommendation form for me and return it to Mr.
Waldman by May, 25, 2012. Thank you for taking time to complete this.
……………………………………………………………………………
Teacher/Staff - Please check the appropriate box when describing this student.
Characteristic
Below Average
Average
Above Average
Outstanding
Leadership
Effort
Citizenship
Scholarship
Overall Potential
Teacher narrative: ____________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
Teacher Signature: __________________________________
Teacher Printed Name: ________________________________
Phone: (571)-252-2030
www.loudoun.k12.va.us/schools/smarts

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