National Honor Society

Belleville West High School

4063 Frank Scott Parkway West

Belleville, Illinois 62223

(618) 222-7500

Brandon Hentze, co-adviser

Lisa Quandt, co-adviser

Unity Project Participation Form

** This form MUST be turned in to your adviser within two (2) school days of project completion.

NHS member/candidate (please print)___________________________________________________

Adviser:________________________________    

• Junior

• Senior

Unity Project Name__________________________________________________________________

Date completed______________________________   Location  ______________________________

Start time ___________________         End time_________________   Total hours ____________

Description of work__________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

I certify that the above candidate/member has successfully completed the Unity Project as described above.  A Unity Project should include a minimum of four (4) hours.

Student signature__________________________date____________

Project coordinator_____________________________date_________