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.

Once you submit this form, we will reach out to you as soon as possible with some more details and suggestions for starting up! If you have any questions, please feel free to reach out to our chapter coordinator, Claire Rosenfeld, at We look forward to working with you!

Applicant 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
Applicant 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.
Your answer
Applicant Phone Number *
Your answer
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
Name (Nickname) 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. PERIOD @ [YOUR LOCATION], [YOUR NICKNAME]
Your answer
Location of your Period Chapter *
Please format your answer as "City, State"
Your answer
Mailing Address for your Period Chapter *
Please provide your mailing address. This mailing address will receive all correspondence, stamps, and other materials from HQ.
Your answer
What type of chapter are you forming? *
So far, how many individuals have joined your chapter? *
No worries if this number is no one yet, 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
How did you hear about PERIOD?
If you were referred by a PERIOD Ambassador please put the first and last name of the person who referred you in the "OTHER" section.
Please read through the following expectations of each Period Chapter and electronically sign with you initials. *
Requirements/Expectations of Period Chapters: (1) All chapter presidents must complete surveys every two months about their progress as a chapter; (2) All chapters must keep our Chapter Coordinator up to date on any new partnerships established; (3) 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; (4) 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. (5) By initialing below you are agreeing to the accept the terms of the Period Memorandum of Understanding found here:
Your answer
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