Ernest Everett Just Middle School's Rose Court/ Gentlemen's ...

Ernest Everett Just Middle School’s
Rose Court/ Gentlemen’s Association
Membership Application
Applications are being accepted on the first Friday of each month through the month of
December 2005. Submit applications to the front office.
Part I: Student Information
1. Name: ______________________________________________________
2. Date of Birth: _MM/DD/YY_
3. Gender: Female (Rose Court) Male (Gentlemen’s Association)
4. Full Address: _________________________________________________
City:________________________ State: _____Zip Code: _______
5. Home Phone: (____)_____-_________
6. School: ________________________________________________
7. Grade: __________________
8. Have you ever heard of the Rose Court/Gentlemen’s Association before ______
If so, from who _________________________________________________
9. What do you look forward to in this organization
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________
10. What are some of your personal interests
________________________________________________________________________
________________________________________________________________________
Part II: Parent Information
A. Female Guardian
1. Name: ___________________________________________________________
2. Full Address: ____________________________________________________
City: ________________________ State: _______ Zip Code: ______
3. Home Phone: (_____)______-_________
4. Work Phone: (_____)______-_________
5. Are you interested in helping with the coordination and committee work of the Rose
Court or Gentlemen’s Association _____________________________
If so, what would you be interested in working on
________________________________________________________________________
________________________________________________________________________
Would like to participate in one of the following If so, circle one:
Volunteer Coordinator
Project Coordinator
B. Male Guardian

1. Name: ______________________________________________________________
2. Full Address: ______________________________________________________
City: ______________________ State: _______ Zip Code: ________
3. Home Phone: (_____) _____-______
4. Work Phone: (_____) _____-______
5. Are you interested in helping with the coordination and committee work of the Rose Court
or Gentlemen’s Association _____________________________
If so, what would you be interested in working on
__________________________________________________________________________
__________________________________________________________________________
Would like to participate in one of the following If so, circle one:
Volunteer Coordinator
Project Coordinator
Part III: Student Requirements
A. Prepare and attach you resume. It should include:
• Name
• Contact information
• Educational background/ grades
• Schools previously attended
• Honors/achievements
• Special abilities
• Service and/or rank experienced
• Church
• Other activities
• Preferences
B. Write a personal goal statement. Include a goal statement for each of the following:
home/family, academic, health, and spiritual.
C. Define “leadership”. How will membership in this organization strengthen your
leadership skills
D. What will you contribute to the club What do you hope to achieve because of
membership in the club
E. Write an essay about personal challenges or barriers. How have you conquered these
barriers or plan to tackle these barriers
F. Where will you be and what will you be doing at the age of 25 Pretend you are 25 years
old and write an essay about your life.
Part IV: Confirmation

I, ______________________________________, would like to be a part of the Rose Court/
Gentlemen’s Association for the 2005-2006 school year. In order to remain in this organization, I
will meet all of the aforementioned criteria and set my personal standards high.
Student Signature _____________________________________________________
Date _____________________________
I/We, _____________________________________, give permission to my/our child,
______________________________________, to participate in Rose Court/ Gentlemen’s
Association for the 2005-2006 school year. I will strive to help my child to maintain the
standards required and will support him/her and the organization.
Parent/Guardian Signature(s)
________________________________________________________________________
Date ______________________
Part V: Officers
If you are interested in being an officer for the Rose Court or Gentlemen’s Association, please
check which office you would like to run for. Following the list, please indicate why you would
like to hold this office. There are officers for both 7 th and 8 th graders so please circle your grade.
7 th grade 8 th grade
President
Vice President
Secretary
Treasurer
Sergeant-At-Arms
Historian
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________