The NSA realizes it is important to institute certain safeguards because many activities occur away from the NSA National Office (local youth, teen and adult chapters, Youth Days, regional meetings, etc) and involve children, teens, and vulnerable adults. Therefore, it has implemented the screening process to help ensure the protection of the children, teenagers and/or vulnerable adults participating in events sponsored by the NSA.

This screening form must be completed by all persons requesting to volunteer in a leadership capacity and who will be engaging in any National Stuttering Association (“NSA”) activities with or around children, teenagers, and/or vulnerable adults. This is not an employment application. The information provided in this screening form is used to help the NSA provide a safe and secure environment.

NOTE: Anyone wishing to serve as a Chapter Leader MUST reach out to their Regional Chapter Coordinator (RCC) before submitting this form. Your RCC or Family Programs RCC can be found on your state page in our NSA chapter directory.

Chapter Leader Volunteer Screening Consent Form

Volunteers are required to fill out the application and background criminal (not credit) check below before being approved as Chapter Leader, Regional Chapter Coordinator, Family Chapter Leader or any other NSA event.

Step 1 of 2

  • Name and address of current employer
  • If yes, please contact Executive Director to discuss.
  • If yes, please contact Executive Director at to discuss.