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MSHA Ambassador of the Year

The Missouri Speech-Language-Hearing Association (MSHA) announces that our Ambassador of the Year campaign is now accepting nominations for a child (ages 3-20) and/or an adult (21 and over). "Better Hearing and Speech Month,” promoted in May joined by our Ambassador brings the awareness to speech, language and hearing disorders and their treatment to life. Please help us by nominating your favorite accomplished patient or client. As our Ambassador(s), the chosen person(s) will represent the thousands of people in Missouri who present communication problems.

The Ambassador(s) will be presented the Ambassador of the Year Award(s) at the MSHA Annual Convention.

The Contest Rules Are As Follows:

  1. Nominations must be sponsored by MSHA members.
  2. Child nominees must be at least three years of age by May 1, 2013.
  3. Adult nominees must be at least 21 years of age by May 1, 2013.
  4. Nominees must present a significant hearing, speech and/or language problem as documented by an audiologist and/or speech-language pathologist.
  5. Nominees must be able to attend and accept recognition at the MSHA Convention. The person(s) selected as Ambassador(s) may be asked to make other public appearances.
  6. Chosen nominees, with the assistance of family/care providers as needed, must write a maximum 500-word statement of explanation on how their audiologist and/or speech-language pathologist participated in their communication ability.
  7. Submissions accepted October 15, 2014 thru January 15, 2015. No exceptions or extensions will be permitted.
  8. The following supportive data must accompany the entry form below:
    • Professional estimate of the person’s hearing, speech and/or language problem
    • Current audiogram (if appropriate)
    • Good quality colored photograph.

Please note: After completing the form below, you will be directed to a new page to upload the above supportive data. The files should be named to inlcude your name and document type (e.g., Smith-Photo, Smith-Esitmate...).

Questions: Contact the MSHA Central Office, 1-888-SAY-MSHA (1-800-729-6742).

ALL ENTRIES BECOME THE PROPERTY OF MSHA AND THE DECISIONS OF THE EXECUTIVE BOARD ARE FINAL.

Be Sure to Nominate Your Favorite Person Today!

MSHA Ambassador Entry Form


Submissions accepted October 15, 2014 thru January 15, 2015. No exceptions or extensions will be permitted.

Adult Child
Person's Name:
Birthdate:
Lives with:    Description of Other:
Name of Father/Mother:
Other:
Address:
City: State:  Zip:
Phone: (W) (H) (C)
Brief biographical sketch of the person, include a description of the family:

General Description of the person's communication Skills:

General Description of the person's personality (e.g, likes, dislikes, favorite activities, behavior among peers, etc:
Sponsor's Name:
Sponsor's Phone: (W) (H) (C)
Sponsor's Email:
 

Please check the agreements below:

I have obtained permission from the appropriate guardian/individual to submit this person in the contest.
I hearby and voluntarily without compensation, authorize use by MSHA of photographs and biographical information about this contestant. I understand that those these photographs and this information may be used in MSHA publicity.
 
After submission of this form, please email the MSHA Office your rofessional estimate of the person’s hearing, speech and/or language problem; current audiogram (if appropriate), good quality colored photograph. The files should be named to inlcude your name and document type (e.g., Smith-Photo, Smith-Esitmate...).

 

 

 
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Missouri Speech-Language-Hearing Association
2000 East Broadway, PMB 296
Columbia, MO 65201-6009
1-888-729-6742 | 1-888-729-3489 (fax)
msha@showmemsha.org