American Speech-Language-Hearing Association

State Association Application for Student Advocacy Form

A grant of $1,000 is available to state associations interested in developing/increasing student participation in State Advocacy Day activities.

* indicates required field.

Plan Summary

In the space below, please summarize (5–6 paragraphs) your state's plan to increase student participation in advocacy. Please be sure to describe how you plan to work with the university training programs and National Student Speech-Language-Hearing Association (NSSLHA) Chapters to promote interest in the program and give us some ideas on how you might recruit students to participate. Materials on planning an Advocacy Day and tips for increasing student participation are available on the ASHA website.*

Estimated Budget

In the section below, provide an estimate of how you plan to utilize these funds. Please be aware that we will require receipts of actual expenditures should your state association receive an award. Use N/A if not applicable.

Budget Item

Cost

Meeting Space (fees associated with meeting space at or near the capital):*

Food/Beverage (breakfast/lunch/snacks provided to volunteers):*

Travel Expenses (gas money, for student/advisor travel, mileage reimbursement; charter bus for student groups):*

Resource Materials (handouts, brochures, briefing materials):*

Photocopying:*

Giveaways (t-shirts for student volunteers, coffee mugs, pens or other items with state association logo to leave behind):*

Other (equipment rental, AV):*

Total (up to $1,000):*

State Association Contacts

Primary Contact

First Name:*

Last Name:*

Phone Number:*

E-mail:*

Alternate Contact

First Name:*

Last Name:*

Phone Number:*

E-mail:*

State Association President's Approval

By signing below, I agree that funds awarded for this project will be spent on Student Advocacy Day activities and that an evaluation summary and receipts will be submitted at the conclusion of the Advocacy Day event.

President's Name:*

Today's Date (MM/DD/YYYY):*

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