Chapter Recertification Form

Local chapters are required to recertify with the national office annually to maintain affiliation with the national association, and to apply for national awards and honors.

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(s) must have current membership in ASHA; they are not required to have ASHA certification.
  • The chapter officers must have national membership in NSSLHA.
  • A link to the application management system will be provided for chapters to upload the following:
    • A list of the chapter's members who are not national members.
    • A copy of the chapter's bylaws. If the National Office already has a copy of your bylaws, you only need to submit a copy when you make revisions.
    • A copy of the chapter's W-9 form [PDF], or a letter of eligibility for 501(c)(3) status, or the equivalent for chapters outside the United States.

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 local members of your NSSLHA chapter?*

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:*




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:*

Campus Affiliation Information

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


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

What is two plus three?*

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