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NSSLHA Regional Councilor Application

(Regions 1, 3, 4, 6, 9)

The deadline for applications is April 18, 2011. Letters of recommendation and resumes must be received by April 18, 2011. Application materials are not complete until all materials are received in the national office:

  • Completed Application
  • Resume
  • Statement of Interest
  • Reference Letters From One Professional and One Student

More information is available on the NSSLHA Executive Council FAQ page.

* indicates required field.

 

Applicant Information

Applicant First Name:*

Applicant Last Name:*

NSSLHA Account Number:*

Are you a member of your local NSSLHA chapter?

Region (locate your region):*

Do you use social networking sites?*

If yes, which sites do you use?

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

Facebook

Twitter

Digg

Blog

Other

Contact Information

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

City:

State:

Zip Code:

Phone Number:*

Fax:

E-mail:*

Education
Applicants must be enrolled in school (undergraduate, graduate or a combination of both) for at least 3/4 of the 2 year term. A CF is not considered part of the 3/4. If an applicant has a question about their eligibility, they should contact NSSLHA at nsslhaprograms@asha.org.

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:

I am currently enrolled in a graduate program.*

If yes, I am in my:

If no, 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 the Regional Councilor position is a voluntary position with a two-year term.*

I understand it is essential that the Regional Councilor attend two 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, MD) and one or two American Speech-Language-Hearing Association (ASHA) committee/board meetings annually (dates to be determined).*

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

I would like to be considered for the alternate 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.*


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 joined NSSLHA because...*

I applied for a position on the NSSLHA Executive Council because...*

During my two-year term on the council, I will be successful if I accomplish...*

My vision for my region is...*

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.

 

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