American Speech-Language-Hearing Association

Distinguished Students of Service Application

The Distinguished Students of Service (DSS) Honor rewards students for being engaged in service on the local, state, and national level. Local and national members of NSSLHA are eligible to be recognized for the DSS Honor.

Service hours for DSS recognition in 2014 is for service performed August 1, 2013 thru June 30, 2014.

Gold

At least 180 hours of service

  • Local NSSLHA chapters—at least 120 hours of service
  • State associations—at least 36 hours of service
  • National NSSLHA—at least 24 hours of service

Silver

At least 120 hours of service

  • Local NSSLHA chapters—at least 60 hours of service
  • State associations—at least 36 hours of service
  • National NSSLHA—at least 24 hours of service

Bronze

At least 60 hours of service

  • Local NSSLHA chapters—at least 30 hours of service
  • State associations—at least 18 hours of service
  • National NSSLHA—at least 12 hours of service

Instructions: Please fill in the information below and mark the number of service hours performed during the 2013-2014 academic year. For more information, contact NSSLHA Programs at nsslhaprograms@asha.org.

* indicates required field.

Applicant Contact Information

NSSLHA Account Number:

First Name:*

Middle Initial:

Last Name:*

Maiden Name (if applicable):

Mailing Address:*

City:*

State:*

Postal Code:*

E-mail:*

University Name:

Region (locate your region):*

Are you a graduate or an undergraduate?

 

Applicant Profile

Are you a member of your local chapter?*

 


Are you a student in a speech-language pathology assistants program?*

 


Are you in a Distance Learning Program?*

 

Education

Undergraduate Education

I am currently enrolled in an undergraduate program.*

 

If yes, I expect to receive my bachelor's degree (MM/YYYY):

Area:

 

If other, please specify.

Name of University Awarding Bachelor's Degree:

Graduate Education

I am currently enrolled in a graduate program.*

 

If yes, I am in my:

 

I expect to receive my graduate degree (MM/YYYY):

University Awarding Degree (not applied or accepted, use "undecided"):

Area:

 

If other, please specify.

Area of Professional Interest (e.g., pediatrics, geriatrics, swallowing, child language, vestibular, undecided):


Service Hours Performed

Local NSSLHA Chapter

Are you a member of a local NSSLHA Chapter?*

 

Enter 30 service hours.

Are/were you an officer in your local NSSLHA chapter?*

 

If yes, what office?

Enter 30 service hours.

Are/were you the chair of a committee in your local chapter?*

 

If yes, what committee did you chair?

Enter 30 service hours.

Did you volunteer for an event or participate in a fundraising activity hosted by your local chapter?*

 

If yes, what is the name of the event?

Enter 30 service hours.

Did you attend a local chapter meeting?*

 

If yes, how many meetings did you attend?

Enter 1 service hour for each meeting that you attended.

Did you participate/attend any other events not listed above?*

 

If yes, please provide more details.

Enter 1 service hour.

State Associations

Are you a student member of your state association?*

 

Enter 18 service hours.

Are/were you serving as a student member on a state association board?*

 

If yes, what was the board name?

Enter 18 service hours.

Are/were you participating, volunteering, or attending any state conventions?*

 

If yes, what is the name of the event?

Enter 18 service hours.

Did you volunteer for an event or participate in a fundraising activity for use at the state level?*

 

If yes, what is the name of the event?

Enter 18 service hours.

Did you attend a state association meeting?*

 

If yes, how many meetings did you attend?

Enter 1 service hour for each meeting that you attended.

Did you participate in any other events not listed above for a state association?*

 

If yes, please provide more details.

Enter 1 service hour.

Did you participate or attend state hill day activities (virtual hill days included)?*

 

Enter 18 service hours.

Did you read a state association website, newsletter, and/or other communications (blogging, webinar, etc.)?*

 

Enter 1 service hour.

National NSSLHA

Do you have national membership with NSSLHA?*

 

Enter 12 service hours.

Did you volunteer for an event or participate in a fundraising activity through National NSSLHA?*

 

If yes, what was the name of the event?

Enter 1 service hour.

Have you written/applied to NSSLHA Community Service or McKinley Grants?*

 

If yes, what is the name of the event or service?

Enter 12 service hours.

Have you ever applied to NSSLHA Honors?*

 

If yes, which honor did you apply for?

Enter 1 service hour.

Has your chapter ever been nominated for NSSLHA Honors?*

 

If yes, which Honor was that Chapter awarded?

Enter 1 service hour.

Did you participate in any other events not listed above?*

 

If yes, please provide more details.

Enter 1 service hour.

Have you read any NSSLHA publications (NSSLHA Now!, In the Loop, CICSD, etc.)?*

 

Enter 1 service hour.

Have you read any ASHA publications (The ASHA Leader, online journals, Perspectives, etc.)?*

 

Enter 1 service hour.

Have you ever visitied ASHA.org and/or NSSLHA.org?*

 

Enter 1 service hour.

Did you complete your profile on the ASHA Community?*

 

Enter 1 service hour.

Do you follow NSSLHA or ASHA on any social networking sites (Facebook, etc.)?*

 

Enter 1 service hour.

Have you participated on a video located on the NSSLHA YouTube channel?*

 

Enter 1 service hour.

Have you participated in an event for the NSSLHA Loves campaign?*

 

If yes, what was the event?

Enter 1 service hour.

Did you participate in any National NSSLHA recruiting activities?*

 

If yes, what was the activity?

Enter 1 service hour.

Have you participated in a National Hill Day sponsored by NSSLHA (virtual day included)?*

 

Enter 1 service hour.


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