American Speech-Language-Hearing Association

Information For:

Chapter Recertification Form

Local chapters are required to recertify with the national office annually to maintain affiliation with the national association.

Guidelines for Recertification

  • Chapters must recertify at the beginning of the academic year, or anytime there is a change in the Chapter Advisor(s) or officers.
  • The Chapter Advisor must have current membership in ASHA, even if they are not ASHA-certified.
  • The chapter officers must have national membership in NSSLHA.
  • A copy of the chapter's bylaws must be on file with the National Office. (If the National Office already has a copy of your bylaws, you only need to submit a copy when you make revisions). Chapters may e-mail a copy of their bylaws to nsslhaprograms@asha.org.

More information about maintaining an active NSSLHA chapter is available.

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Chapter Details

Region Number (locate your region):*

Chapter Category:*

How many students are enrolled in your chapter's audiology and/or speech program?*

How many students are local members of your NSSLHA chapter?*

How many students in your chapter have national NSSLHA membership?*

How much are your local chapter dues?*

In what month does your chapter hold officer elections?*

What is the date of the first membership meeting in the fall semester (MM/DD/YYYY)?

What is the date of the first membership meeting in the spring semester (MM/DD/YYYY)?

How often does your chapter hold meetings?*


Chapter Contact Information

College or University name:*

Chapter mailing address:*

City:*

State/province:*

Country:*

ZIP/postal code:*

Office phone number:*

Primary chapter contact e-mail address:*

Web address:


Chapter Advisor Contact Information

Chapter Advisor's first name:*

Chapter Advisor's last name:*

Chapter Advisor's ASHA account number:

Chapter Advisor's e-mail address:*

How long has s/he served as a chapter advisor?*

Co-Advisor's first name:

Co-Advisor's last name:

Co-Advisor's ASHA account number:

Co-Advisor's e-mail address:

How long as s/he served as a co-advisor?


Chapter Officers' Contact Information

Chapter President's first name:*

Chapter President's last name:*

Chapter President's NSSLHA account number:

Chapter President's e-mail address:*

Chapter President's first day of office:*

Chapter Vice-President's first name:*

Chapter Vice-President's last name:*

Chapter Vice-President's NSSLHA account number:

Chapter Vice-President's e-mail address:*

Chapter Vice-President's first day of office:*

Other Officer 1, first name:

Other Officer 1, last name:

Other Officer 1, NSSLHA Account Number:

Other Officer 1, e-mail address:

Other Officer 1, title:

Other Officer 1, first day of office:

Other Officer 2, first name:

Other Officer 2, last name:

Other Officer 2, NSSLHA account number:

Other Officer 2, e-mail address:

Other Officer 2, title:

Other Officer 2, first day of office:


Campus Affiliation Information

Is your local NSSLHA chapter required to register with your college or university?*

 

How is your local NSSLHA chapter recognized by your college or university? (select one)*

                  

Does your college or university require the following to register/recognize your local NSSLHA chapter? (select all that apply)*

       

What rights/privileges does your college or university give to your local NSSLHA chapter? (select all that apply)*

       

To prove that you are a real person, please answer the following math problem.

What is two plus three?*

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