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Apply to Become an NCCC Representative

As an NCCC representative, you will help raise cervical health awareness by sharing trusted resources, supporting social media campaigns, and connecting people to NCCC programs and support services.

NCCC community representatives commit just 3-4 hours per month, participate in fun community challenges, and can win prizes! In this role, you may participate in health fairs, speak on panels, host educational events, and engage in fun NCCC challenges to support local outreach efforts.

All representatives receive PEACH Certification by completing a brief online course and are awarded 100 free business cards to help engage with their communities.

3-4 Hours per Month

Community Activites

Win
Prizes

Grad Forks Public Health team

Apply to Be a Chapter Representative

Chapter Representative Application
Your Name
Your Name
First Name
Last Name
Address
Address
City
State/Province
Zip/Postal
0 of 300 max characters

As a chapter representative, 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:

  • Speak truthfully and accurately.
  • Disclose your affiliation with ASHA/NCCC in all activities you participate in.
  • Avoid giving medical advice. Clarify that you are sharing personal experiences or opinions only.
  • Remind others that only physicians can prescribe medications or determine treatment.
  • Speak only about the FDA-approved (“on-label”) uses of medications.
  • Respect others’ right to form their own opinions based on the information you share.
  • Protect privacy—never share personally identifiable health information.
  • Only involve minors (under 18) with the direct participation of a parent or legal guardian.

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

Acknowledgement