Period Chapter Application Form
Before filling out this form, please read through the "What is a Chapter?" page on our website to understand more about the three pillars of our program. Also, it would be best to create a chapter email, such as

Once you submit this form, we will reach out to you within 7 business days with some more details and suggestions for starting up! If you have any questions, please feel free to reach out to our Programs Director, Eira, at We look forward to working with you!

Email address *
Chapter President Name *
The representative of your chapter will be the main contact for correspondence with Period., and will step in as the chapter president.
Your answer
Chapter Email *
Please list the best email to contact your chapter through. This can either be the email of your chapter president/representative, or it can be the contact email for your chapter as a whole. We prefer the latter and encourage chapters to have an email that can look something like this: Make sure you actually create that email account!
Your answer
How did you hear about us?
Applicant/Contact Phone Number *
Your answer
Would you like us to occasionally text you at this number?
The mission of Period is to celebrate and provide menstrual hygiene products to those in need. Please explain how your chapter will make a difference through the three core pillars of our impact (advocacy, education, and service). *
Please see the "What is a Chapter?" page on our website for more details on these three pillars of our program.
Your answer
Chapter Affiliation (school or organization name)
Your answer
Name of your Period Chapter *
The name of your chapter should be pretty concise. If you are part of a school or organized institution, please include the name of your school/organization in the chapter name. This name will also be included in your customized Period Chapter logo. Example: PERIOD @ Portland State University. If your school or organization name doesn't include a city or state, we will add that. Example: instead of PERIOD @ Lincoln High School, we would use PERIOD @ Lincoln HS, Portland OR.
Your answer
Street Address for your Period Chapter *
Please provide the street address for mailings. This mailing address will receive all correspondence, stamps, and other materials from HQ.
Your answer
Your answer
State *
Your answer
Zip Code
Your answer
Your answer
What type of chapter are you forming? *
So far, how many individuals have joined your chapter? *
No worries if this number is only one right now, please give an estimate of how many pledged members that you have.
Your answer
How do you plan to engage and recruit more members for your chapter? *
Your answer
Please read through the following expectations of each Period Chapter and electronically sign with you initials. *
Requirements/Expectations of Period Chapters: (1) All chapters must submit a $50 annual fee to receive the toolkits and staff support. (2) All chapter presidents must complete surveys quarterly, or as requested, about their progress as a chapter; (3) All chapters must keep our Programs Director up to date on any new partnerships established; (4) Once funds are collected, chapters must keep record of what they are spending their money on and donate any leftover funds at the end of the term back to Period as a parent organization; (5) Chapters are expected to share pictures and videos of club activities, and social media links to any chapter accounts or advocacy campaigns that are established by the chapter so we can help spread word about your activities. (6) By initialing below you are agreeing to the accept the terms of the Period Memorandum of Understanding found here:
Your answer
Once your chapter has been approved: In order to receive your toolkits and PERIOD stamp, please submit your annual chapter dues ($50) via Paypal to or via check to 422 NW 13th Ave., PMB 215, Portland, OR 97209. The Chapter Coordinator will be reaching out to you shortly. If chapter dues will pose a problem for you, please contact our Programs Director, Eira Nylander ( and explain your situation.
Be sure to indicate which chapter you are representing on your payment. Thanks so much!
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