Second Major Activity: Years Involved: 9 10 11 12 □ □ □ □ Positions Held and/or Honors Received: Briefly describe your involvement: Moderator’s Signature: Date: Moderator’s Comments: Other Activities Activity # Hours Per # Weeks Per Moderator Involved Week Year Signature
Second Major Activity: Years Involved: 9 □ 10 □ 11 □ 12 □ Positions Held and/or Honors Received: Briefly describe your involvement: Moderator’s Signature: Date: Moderator’s Comments: Other Activities Activity Involved # Hours Per Week # Weeks Per Year Moderator Signature
2017%20Fall%20application%20for%20NHS.docx