Chapter Leader Application
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  NCCC Chapter Application Process & Rules  

Step 1: Apply

  • Complete and submit the Chapter Application.

  • Submit a background check application. Clearance is required before a chapter can be activated.

Step 2: Acceptance & Planning

  • Once contacted by NCCC Manager, complete Background Check, submit an Annual Plan outlining your chapter’s goals, activities, fundraisers, and educational events.

  • Submission of this plan is required to become an active chapter.

What We Ask of Chapter Leaders

  1. Have fun and stay inspired!

  2. Submit an Annual Plan each year to raise awareness of HPV and cervical cancer in your community.

  3. Fundraise at least $100 (net) each year.

  4. Stay in regular contact with the Headquarters office.

What ASHA/NCCC Provides to You

  1. Comprehensive support and resources for your success, including:

    • The official NCCC logo

    • An official NCCC email address

    • Business cards

  2. Legal and compliance management, including:

    • Donor acknowledgments

    • State licensing for your activities

    • Financial and tax filings for chapters

  3. Ongoing guidance, tools, and encouragement to help your chapter thrive.

NCCC Code of Conduct

As a Chapter Leader, you agree to uphold the NCCC Code of Conduct. Violations may result in suspension or termination of your role and loss of chapter privileges.

You must always:

  1. Speak truthfully and accurately.

  2. Disclose your affiliation with ASHA/NCCC in all chapter-related activities.

  3. Avoid giving medical advice. Clarify that you are sharing personal experiences or opinions only.

  4. Remind others that only physicians can prescribe medications or determine treatment.

  5. Speak only about the FDA-approved (“on-label”) uses of medications.

  6. Respect others’ right to form their own opinions based on the information you share.

  7. Protect privacy—never share personally identifiable health information.

  8. Involve minors (under 18) only with the direct participation of a parent or legal guardian.

  9. If concerns arise regarding donation management, the ASHA/NCCC Admin team may issue a warning. Chapters may be suspended or terminated at the discretion of the ASHA CEO following such warnings.

Untitled Title
Your name *
Street Address *
City *
State *
Zip *
County
Email *
Phone number *
Birthdate
What are you applying for? *
If you are applying to be a co-leader of an existing chapter, please note which chapter below.
How did you hear about ASHA/NCCC? *
What is your experience with HPV and cervical cancer?
Are you affiliated with any other health advocacy organizations? If yes, please describe your work/involvement.
What are your ideas for your chapter? *
How many people have you recruited or intend to recruit to assist you with the chapter? *
Are you willing to bring other people into your chapter who want to get involved in your area that ASHA/NCCC may refer to you? *
Required
Questions or comments?
I acknowledge that I have read the chapter leader application and accept the outlined responsibilities of a chapter leader and the NCCC Code of Conduct. *
Required
Signature *
(Type your complete name below)
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