Social Studies teacher reference: ____________________________________ email: _____________________________
Other Adult reference: ____________________________________________ email: _____________________________
Students must have a minimum of two adult sponsors who certify the student has met the criteria of scholarship, leadership,
service and citizenship. One must be a social studies teacher. The other may be a teachers, school administrator, or activity
or community service sponsors.
I understand that completing this form does not guarantee selection to Rho Kappa, and that the information presented
here is accurate.
___________________________________________________________________________________________________
Student Signature
Student Name (Printed) Date
I have read the information provided by my son/daughter on this form, and can verify that it is true, accurate, and
complete in its presentation.
___________________________________________________________________________________________________
Parent/Guardian Signature
Parent/Guardian Name
(Printed) Date
To be considered for selection to Rho Kappa, this form must be HANDED to: ____________________________________
It should not be left in a mailbox nor given to another person. No late forms will be considered.
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