Student Advocacy Day Activities Final Report and Expenses Form

State Association Name:*

Date of the Event (MM/DD/YYYY):*

Describe the Event

How many students participated?*

Describe in detail the advocacy event or activity*

What would you change or do differently next time?*

What advice would you have for other states interested in increasing student participation?*

Do you have any suggestions for improving the student advocacy website?

What are your plans to continue to involve students in advocacy day activities?*

*If  you are not planning to involve students in future activities, please explain why?

Budget

Note: Receipts (copies or originals) must be submitted to the ASHA National Office. Submit receipts to: Susan Adams, Legislative & Regulatory Advocacy, ASHA, 2200 Research Boulevard, Rockville, MD 20850.

Please provide the amount spent on the following items used to support your student advocacy day activities.

Food:

Transportation:

Supplies:

If supplies were used, please describe.

Printing:

Photocopying:

Postage:

AV Equipment:

Novelties (gifts, merchandise, etc.):

If novelties were used, please describe.

Other:

If other were used, please describe.

Total:

Completed By First Name:*

Completed By Last Name:*

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