Congratulations on achieving this important 80% screening rate milestone! Your organization is playing an important role in our shared goal to save over 200,000 lives from colorectal cancer. Thank you!

To help us publically celebrate your organization’s success, please complete this form to report your organization’s accomplishment in reaching an 80% colorectal cancer screening rate. Upon approval, your organization’s name will be posted on the 80% by 2018 Hall of Fame webpage and you will receive a copy of the 80% by 2018 Stellar Achievement Web Badge by email. If you have any questions please contact Emily Butler Bell at Emily.Butler@cancer.org.

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* 1. Contact Information:

* 2. Please select the category under which we should list your organization’s achievement:

* 3. What is your current colorectal cancer screening rate?

* 4. For what population did you reach an 80% screening rate?

* 5. How do you calculate your colorectal cancer screening rate? (Select all that apply)

* 6. To what do you attribute your success in achieving 80%? (Select all that apply)

* 7.

In submitting this information, you agree to have your organization’s name listed on nccrt.org’s 80% by 2018 Hall of Fame, which is a public website. NCCRT will require organization's to reaffirm remaining at an 80% screening rate or higher on an annual basis. 

If the NCCRT receives any inquiries about how the 80% screening rate was achieved or calculated, please be aware that we will refer the inquiry directly to you. The NCCRT reserves the right to refrain from posting or remove the name of any organization as necessary to protect the integrity of the site. You may request to have your organization's name removed from the site at any time. 

* 8. Would you also like to receive an 80% Screening Rate Stellar Achievement Web Badge to display on your website and/or social media?

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