ALCSI College Chapter Application Form

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Are you interested in making an impact and saving lives? Apply below to serve as president of a chapter of the American Lung Cancer Screening Initiative (ALCSI) at your college. After submitting, a member of the National ALCSI Leadership will contact you regarding the next steps and will provide you with further information about the chapter initiation process.

ALCSI is a national 501(c)(3) nonprofit that is dedicated to promoting awareness for lung cancer screening for individuals at high risk of developing lung cancer through educational efforts, community outreach, and health literacy engagement. Activities may include advocating for Congress members to support a lung cancer bill, presenting to local communities about the importance of lung cancer screening, and working with local health departments to bring actionable change to your communities. For more information, please visit: https://www.alcsi.org/.

Applications are rolling, so apply as soon as possible.

What is your name?
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What is your email?
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What college do you attend?
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What state/province is your college in? *

What year are you currently in?
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First-Year

Second-Year

Third-Year

Fourth-Year

Graduate

Other

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