LARC Materials Request Form – Health Communication Capacity Collaborative

Please use the form below to submit a request for the HC3 LARC materials.

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LARC Materials

Name
First Last
Position
Project
Organization
Email
Phone
Please specify which materials you wish to use:
Select all that apply, hold down “control” key on your PC or "command" key on your Mac to make multiple selections.
Please describe how and by whom materials will be used:
(e.g., posters will be posted in clinics or pharmacies, health workers will use the brochure as job aides, etc.)
I/my project/my organization request(s) HC3’s permission to (select one of the following):
If you chose Option 1 above, please check below if you agree to make no other changes to the materials’ language, images, marking or branding before reproducing and disseminating.
- I agree
- I do not agree
If you selected Option 1 above, please specify logos that will be added:
If you chose Option 2 above, please check below if you agree to remove both HC3 and USAID logos from the materials before reproducing and disseminating, and will include in their place the following text:
These materials were adapted from USAID-funded materials created under the Health Communication Capacity Collaborative (HC3) Project, made possible by the support of the American People. The contents of this adapted material do not reflect the views of USAID or the United States Government. The original materials can be found here: http://healthcommcapacity.org/technical-areas/family-planning/long-acting-reversible-contraceptives-larcs/
- I agree
- I do not agree
Please check below if you agree to share with HC3 a copy of the revised materials.
- I agree
- I do not agree
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LARC Materials

Headlines

Pages

Categories

Archive