CCR Chapter Application

To submit your report for the certificate program, please complete this application and include a PDF attachment of your report. There is no cost to participate in this program.

Chapter Name

Name of chapter submitting report as it will appear on the certificate.

Fiscal Year Period

Example: July 1, 2024-June 30, 2025 for FY 2024

Report Published Date

How was the report distributed to members and nonmembers?

Describe any public relations/marketing outreach that was used to promote the report.

Web link where the report is posted

Report File

Max. file size: 1 MB.

Contact Information

Used for results letter

First Last

Chapter Title

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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