American Speech-Language-Hearing Association

NSSLHA Regional Councilor Application

(Region 2, Region 5, Region 7, Region 8 and Region 10)

Applications, letters of recommendation, and resumes must be received by March 1, 2014. Application materials are not complete until all components are received in the national office:

  • completed application
  • resume
  • statement of interest
  • reference letters from one professional (i.e., teacher, advisor, mentor, supervisor) and one student

Term Requirements

A position on the Council is a two-year commitment. Candidates may apply if they will be enrolled in a program for at least three academic semesters of the 2-year term. Graduate students are eligible to apply even if they will be in a Clinical Fellowship or externship for 3–6 months of the 2-year term (and have not applied for the Certificate of Clinical Competence [CCC's]).

More information is available on the NSSLHA Governance webpage.

* indicates required field.

Applicant Information

First Name:*

Last Name:*

NSSLHA Account Number:*

Region (locate your region):*


Contact Information

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

City:*

State or Province:*

Postal Code:*

Phone Number:*

E-mail Address:*


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?*

               

Are you an officer of your local NSSLHA chapter?*

               

Share your social networking sites:

Please include a page or blog name for any social networks you use or author.

Facebook

Twitter

Digg

Blog

Other


Education

Undergraduate Education

I am currently enrolled in an undergraduate program.*

               

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

Undergraduate 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"):

Graduate Area:

               

If other, please specify.

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


Assurances

 I understand that if I am selected for the position of Regional Councilor that I must be a current national member of NSSLHA.*

 I understand that it is mandatory for the Regional Councilor to attend three Executive Council meetings. The Council meets in the summer (this is an orientation meeting); in the fall (during the ASHA Convention in November; and in the spring (at the national office in Rockville, MD). All travel and hotel expenses are covered by the national office. *

 I understand that a Regional Councilor may be selected to serve on one or two American Speech-Language-Hearing Association (ASHA) boards or committees (meeting dates vary). Attendance at those meetings is mandatory. All travel and hotel expenses are covered by the national office.*

 I understand that if selected for the position I will allow the NSSLHA Executive Council to select the delegate for my position who will be responsible for completing my term should I not be able.*

 I would like to be considered for the delegate position if I am not selected as a regional councilor.


Race/Ethnicity

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

Race/Ethnicity:

               

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


Resume

You may cut and paste your resume from a Word document into this area or send your resume to nsslhaprograms@asha.org as a separate attachment. If you choose to send your resume 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.*

The biggest benefit that NSSLHA gives to students is...*

What are your leadership strengths and weaknesses and what new experiences and skills do you intend to gain as a regional councilor to help you grow?*


References

Please have one professional and one student provide references on your qualifications for this position. Please encourage them to send their reference letters electronically to nsslhaprograms@asha.org.

Photographs

Send an electronic photograph that may be used for publication to nsslhaprograms@asha.org.

Documents and Attachments

You may share electronic documents or publications, videos, or PowerPoint presentations that will demonstrate your abilities as a leader. Send these attachments to nsslhaprograms@asha.org.

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