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NSSLHA Honors Program Application

Nominations for Honors of NSSLHA and Chapter Advisor Honors must be received on or before February 6. Nominations for Member Honors must be received by May 1. Materials not received by the deadline will not be considered. View the current Honors recipients.

For more information, contact Dawn Dickerson, NSSLHA Director of Operations, at nsslhaprograms@asha.org.

* indicates required field.

Nominee(s)' Information

Area of Consideration:*

First Name of Nominee (if individual being nominated):

Last Name of Nominee (individual):*

Organization Name (if nominating an organization or group for the Honors of NSSLHA or Chapter Honors):

Region Number (locate your region):*

Nominee(s)' Phone Number:

Nominee(s)' E-mail (individual):

Web Address (group, organization, or local chapter, if applicable):

Please describe how the nominee's work has advanced the mission of NSSLHA and/or benefitted CSD students (500 word max).*

One of NSSLHA's goals is to have its membership represent the multicultural diversity of the American society. Please let us know if the nominee meets one of these racial/ethnic categories.

Nominator's Information

Nominator Type:*

Nominator's First Name:*

Nominator's Last Name:*

Chapter, University, Organization, or State Assocation Name:

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

City:*

State:*

Zip Code:*

Phone Number:*

E-mail:*