Chapter Leader Application

• Complete and submit the Chapter Application.
• All applicants will also be required to submit an application for a background check. Background check clearance is a mandatory step in chapter activation.
• Once notified by ASHA of your acceptance, you will be required to submit an Annual Plan with your ideas and how you hope to accomplish them, including fundraisers and educational activities for your chapter in order to become an active chapter.
• After receiving and reviewing your plan, ASHA/NCCC staff will call to ask any clarifying questions and to answer any questions you may have.


1. Provide a phone number, email address, and mailing address.
2. Raise a minimum of $100 annually for the chapter. All fundraising proceeds must be sent directly to ASHA/NCCC. Donations must be paid directly to ASHA/NCCC for the donations to be considered tax deductible. Chapters may not open their own bank accounts to process gifts.
3. Use only official logos approved by NCCC.
4. Participate in a quarterly conference call.
5. Communicate quarterly with your chapter manager regarding the items your chapter accomplished during the previous time period and what the chapter plans to accomplish in the upcoming period. If no updates are received and/or a leader is unresponsive to emails for 60 days, the chapter will be considered defunct and all chapter funds will be forfeited to ASHA/NCCC.
6. Present itself professionally when doing business for the NCCC and will follow all rules and guidelines laid down by the organization.
7. Use letterhead stationery in all official communication. All communication that goes out on NCCC letterhead will be reviewed first by ASHA/NCCC staff.
8. Complete and submit an event registration form 30 days in advance for approval for any event that will be held using the NCCC name and that will have any fundraising/money exchange.
9. Submit any and all contracts valued at $500 or more to NCCC staff for review and approval at least 30 days prior to contract deadline.
10. Complete and submit a post-event activity report within 14 days following the event.
11. Submit all materials that will be distributed by the Chapter for review and approved in advance by ASHA/NCCC.
12. Contact local media during the month of January about Cervical Health Awareness month, and attempt to get local stories run in the media.
13. Agree that Chapters and its members are never allowed to give out medical advice of any kind.
14. Provide administrative access to NCCC staff for all chapter-managed social media (e.g., Facebook, Twitter).


1. Review all applications for starting a chapter within 14 days of submission
2. Provide initial and ongoing training/support on a timely basis.
3. Provide an ASHA/NCCC email address to the chapter leader(s).
4. Provide chapter leader(s) with business cards after the acceptance of the chapter annual plan.
5. Provide an electronic logo to affix to email correspondence.
6. Supply reasonable quantities* of educational and other materials in support of events.
7. Provide seventy percent (70%) of proceeds from local Chapter fundraising events to the Chapters for use in growing their local agenda.
8. Review and sign any and all contracts valued at more than $500 within 14 days of submission.
9. Provide reports of all financial activities within 14 days of request. Our goal is total transparency.
10. Pay bills submitted by the chapter within 14 days of submission and approval by ASHA/NCCC staff. Only those bills associated with a pre-approved events will be paid.
11. Manage state licensing for each chapter.
12. Complete an annual review with feedback based on the annual plan to be submitted.
13.An annual review with feedback will be completed based on the annual plan to be submitted.

* Reasonable quantities to be decided by ASHA/NCCC staff based on your chapter’s previous experience, the plan submitted and supplies available on hand.


NCCC Chapter leaders must adhere to the NCCC code of conduct. Violation of this code of conduct may result in immediate termination of a chapter leader's participation in the NCCC community as well as use of the website and any related services.

1. Always speak accurately and truthfully.
2. Always disclose your relationship with ASHA/NCCC and your participation in any NCCC program.
3. Never give medical advice or represent that you are giving medical advice. Make sure you communicate this to others. Inform others that you are sharing your personal opinion, thoughts, or experiences.
4. Always inform others that only physicians can prescribe medications or decide if a particular treatment option is right for them.
5. Always speak solely about the "on label" prescribed use of a drug.
6. Always allow others to form their own honest opinions based on information you have shared.
7. Always respect the privacy of others at all times. Never disclose their personally identifiable health information or other private information.
8. Never involve a child under the age of 18 in any ASHA/NCCC Program without direct participation of their parent or legal guardian.

Your name *
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Address *
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City, State, Zip *
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Email *
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Phone number *
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What are you applying for? *
If you are applying to be a co-leader of an existing chapter, please note which chapter below.
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How did you hear about ASHA/NCCC?
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What is your experience with HPV and cervical cancer?
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Are you affiliated with any other health advocacy organizations? If yes, please describe your work/involvement.
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What are your ideas for your chapter?
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How many people have you recruited or intend to recruit to assist you with the chapter?
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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?
Questions or comments?
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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. *
Signature *
(Type your complete name below)
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