Submit a Patient Support Resource to the ACS NLCRT

The ACS NLCRT Survivorship Task Group is seeking Roundtable partner resources to enhance our members’ ability to access resources and materials that offer evidence-based information to support patients and their caregivers.

Patient Support Resource Submission

"*" indicates required fields

Contact information:

Name:

First Last

Title:

Role with Resource/Program:

Email:

Phone:

Organization Name:

Organization Website:

Organization type:

non-profit

for-profit

federal/state/local government agency

other – please describe

If other, please describe:

Resource Information

Resource/Program Name:

Publication date:

If updated, please provide the original publication date and date of most recent update.

Description:

Please provide a brief summary of your resource/program.

Evaluation:

If applicable, please describe your organization’s approach for creating and reviewing evidence-based patient facing materials.

Permitted Uses:

Copyright Notices/Attribution: Please note that it is your responsibility to include all copyright notices or attribution language required by your organization prior to linking or uploading resources to the ACS NLCRT Resource Center.

Are all resource/program components available for download via your website or URL?

Resource/Program URL or website:

If YES is selected, your resource will be included via a link to your organization’s website. The Permitted Uses of your resource/program will be described as follows: Made publicly available online by [name of org].

Resource/Program Files:

If NO is selected, Permitted Uses of your resource/program will be described as follows: The materials related to this resource were made available by [name of org]. Please contact [name of org] via the contact information below to inquire about permissions to use these materials.

Please upload relevant files that you would like to share publicly.

Drop files here or

Max. file size: 50 MB.

Contact Information:

Please share contact information as you would like it to appear in the public resource entry (contact name and email is suggested, but only email is required). EXAMPLE: Send comments, questions, suggestions and/or permission requests to [email protected].

Audience:

Setting:

Please check the relevant filters that pertain to your resource or program to assist users in identifying your entry in a search:

CHC/FQHC

Community

Health plan

Hospital/health system

Policymaker

Primary care

Workplace

Patient/Caregivers

Resource Type:

Please check the relevant filters that pertain to your resource or program to assist users in identifying your entry in a search:

Brief/fact sheet

Data analysis tool/calculator

Infographic

Journal article/report

Public Service Announcement

Sample/template

Toolkit/guidebook/ handbook

Training/e-module

Webinar

Media Type:

Please check the relevant filters that pertain to your resource or program to assist users in identifying your entry in a search:

Audio/Podcast

PDF

Spreadsheet

Video

 ACS NLCRT Resource Center Disclaimer
By submitting a resource to the ACS NLCRT Resource Center you agree that: 
1. The submitter understands and agrees that the ACS NLCRT website (nlcrt.org) and ACS NLCRT Resource Center are being administered by the American Cancer Society, Inc. (ACS) on behalf of ACS NLCRT and its member organizations.
2. The ACS is under no obligation to publish your submission.
3. The ACS may use the information entered in the submission form, text image(s), and other uploaded materials as featured content on nlcrt.org without cost or remuneration of any kind to the submitter.
4. You warrant that you have the right or have secured all rights necessary to grant ACS the right to publish your resource in the ACS NLCRT Resource Center and that such publication will not violate any existing right, including without limitation copyright or privacy right.
5. You warrant that you have the right or have secured all rights necessary to permit users of the ACS NLCRT Resource Center to utilize your resource for the “permitted uses” you have indicated and that such uses will not violate any existing right, including without limitation copyright or privacy right.
6. You warrant that the resources include all copyright notices and/or attribution language required by the contributing organization.
7. You agree to hold the ACS, its officers, agents and employees, harmless against any and all claims, demands and actions based upon or arising out of any activities, and shall, at the request of the ACS, defend any and all actions brought against the ACS based upon any such claims or demands arising from or in connection with any use of the submission, including text, image(s), and other uploaded materials.
8. You understand that you are submitting materials for the purpose of display on nlcrt.org, including email addresses and other contact information, if submitted.
9. You certify that you are 18 years of age or older and that you are authorized to make this submission, and the certifications and permissions on behalf of your organization.

If you agree to the ACS NLCRT Resource Center Disclaimer please check the checkbox below.

ACS NLCRT Resource Center Disclaimer Agreement*

I agree to the ACS NLCRT Resource Center Disclaimer

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