Application and Agreement for Regional Affiliation with the Association on Higher Education and Disability ahead affiliate Program

An AHEAD Affiliate shall be a group of professionals actively working to enhance higher education opportunities for people with disabilities in a defined geographic area.

The AHEAD Board of Directors will review initial bylaws and mission statements as well as changes to either from a state or regional group or organization applying for or renewing as an AHEAD Affiliate. The AHEAD Board of Directors will review and approve or reject all applications for affiliation.

The AHEAD Affiliate program began in 1998. As of 2007, the Affiliate program is structured such that following initial approval as an AHEAD Affiliate, each AHEAD Affiliate will renew its affiliation with AHEAD annually. Nominal fees are charged for initial application and affiliation renewals, as set by AHEAD.

Regional Affiliates of AHEAD are wholly independent entities from AHEAD. No legal or insurance benefits accrue as a result of the voluntary affiliation relationship with AHEAD. As separate operating entities, Regional Affiliates are solely responsible for their fiscal operations.
Affiliates agree to:

1. 
   Establish and maintain a mission statement consistent with that of AHEAD;
   
2. 
   Use the AHEAD name and trademark according to prescribed standards;
   
3. 
   Include information on affiliation with AHEAD on its website with link to www.ahead.org., actively promote AHEAD membership and member benefits at Affiliate-sponsored activities, distribute materials provided by AHEAD;
   
4. 
   Designate a member of the Affiliate’s governing board who is an active member of AHEAD to serve as liaison between the Affiliate and AHEAD. The Affiliate will notify AHEAD within thirty (30 days) when there is a change in the liaison representative.
   
5. 
   Designate one Affiliate member to attend the national conference and represent the Affiliate at the Affiliate Council meeting;
   
6. 
   Notify AHEAD of changes to the Affiliate’s mission and/or bylaws in a timely manner.
   

1. 
   Formal recognition and promotion of the Affiliate and its members, activities and resources;
   
2. 
   Infrastructure and technical support for the Affiliate to have a World Wide Web presence and electronic communication through existing technology, which may include but not be limited to: a web site, discussion forum, listserv, moderated chat;
   
3. 
   Expert assistance and consultation regarding association management issues such as insurances, finances, tax reporting, membership promotion, event management, publication production, etc.;
   
4. 
   Assistance with implementing and promoting regional professional development activities;
   
5. 
   To include the Affiliate’s name on its website and in distributed materials about affiliation;
   
6. 
   The opportunity to apply for funds or other resources to support activities of AHEAD Affiliates;
   
7. 
   The opportunity to promote affiliate membership through AHEAD’s existing membership recruitment and retention mechanisms;
   
8. 
   Materials to promote Affiliate and AHEAD membership and member benefits;
   
9. 
   A reasonable level of legal review of official written documents produced in the name of an Affiliate of AHEAD.
   

AHEAD, 107 Commerce Center Drive, Suite 204

Huntersville, NC 28078 USA
Required attachments include:
1) the organization’s bylaws and mission statement,

2) a complete list of the names and titles of the organization’s officers, and

3) name of designated liaison with AHEAD (page 3 of this application)

Name for the regional affiliate (include “AHEAD” if desired)

Name and title of chief officer

Postal Address

Voice phone Fax e-mail
Does your group currently have a web site?______ If yes, what is the URL
If the application for affiliation is approved, does AHEAD have permission to link to it?
On behalf of the above-named organization, I hereby apply for regional affiliation with AHEAD. The terms of this affiliation, as set forth on pages 1 and 2 of this document, are agreed to with this signature.
Signature Date

Payment Information

(Please indicate and provide appropriate information applicable to your form of payment)
____Check enclosed payable to AHEAD in US Funds

____Purchase order for AHEAD

Purchase Order #__________________________

____Credit Card (VISA, MasterCard, Discover, Amex)

____________________________________________

Expiration Date: ____/____

Three digit security code: _____

Cardholder’s Name (as it appears on the card):

____________________________________________

Cardholder’s Signature:

____________________________________________

(Printed name, and board title)

(Address)

Forwarded to ________________________ on _________

Application approved _____ denied _____ date _________

Group notified by __________________________ on __________