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NSSLHA Executive Council Consultant Application

The NSSLHA Executive Council is currently recruiting ASHA members for the position of National Advisor.

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Applicant Information

Applicant First Name:*

Applicant Last Name:*

ASHA Account Number:

Region (locate your region):*

Are you currently a local NSSLHA chapter advisor?

Chapter Name:

Area of Professional Interest (e.g., pediatrics, swallowing, audiology):

Contact Information

Mailing Address (all correspondence will be sent to this address):



Zip Code:

Phone Number:*




I understand that the consultant position on the NSSLHA Council is a voluntary position with a three-year term.*

I understand that it is essential that the consultant attend three NSSLHA Executive Council meetings (one meeting occurs during the ASHA Convention in November; the other meeting is held in the spring at the national office in Rockville, Maryland and there is an orientation in the summer).*

I understand that if selected this position may require 5 - 8 hours per month of my time engaged in conference calls or work assignments on behalf of the Executive Council and/or the association.*


One of NSSLHA's goals is to have its membership represent the multicultural diversity of American society.


Tribal Affiliation (for American Indians - including Alaskan Natives):


You may cut and paste your resume or curriculum vitae from a Word document into this area or send your resume or CV to as a separate attachment. If you choose to send your resume or CV via e-mail, please type "sending via e-mail" in the space provided. If you are copying and pasting your resume below, please note that any formatting in Word will not transfer into the following box.*


Statement of Interest

Please provide the NSSLHA Executive Council with a statement that explains your interest in the position. Please answer all questions and limit your responses to 500 words or less.

I am interested in this position because…*

In my professional career, I am most proud of…*

During my three-year term on the council, I will be successful if …*

I will manage the responsibilities of the position and my paid work assignments in the following way…*


Please have one professional and one student provide a letter of support on your qualifications for this position. Letters of support must be received electronically to

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