Introduction: Although colorectal cancer (CRC) is the second leading cause of cancer-related deaths among men and women combined in the United States, only 61% of eligible adults are up-to-date with current screening recommendations. Effective screening is hindered by numerous barriers and underutilization of evidence-based interventions. The purpose of this clinical dissertation project was to increase CRC screening in the rural community of Elgin, North Dakota, determine the efficacy of providing targeted educational handouts and endorsement letters, and to identify screening barriers and facilitators. Methods: Educational handouts and screening endorsement letters were developed and distributed to 75 average risk patients (without personal or family history of CRC or certain types of polyps, personal history of inflammatory bowel disease, personal history of receiving radiation to the abdomen or pelvic region, and confirmed or suspected hereditary CRC syndrome). Additional handouts were placed around the community of Elgin. Patients who presented for CRC screening were sent a questionnaire to determine the impact of the interventions. These 75 patients were also contacted via telephone and completed a questionnaire to identify barriers and facilitators and to highlight the effectiveness of the educational handout and the endorsement letter. Results: Five patients contacted the clinic to receive CRC screening. Ninety-seven percent of patients who recalled receiving the endorsement letter and educational handout (n=32) found the material to be informative, 91% of patients appreciated being contacted on behalf of the clinic, and 59% found the handwritten signature on the endorsement letter to be influential. Fifty-one patients identified screening barriers including (in descending order) lack of awareness/knowledge, cost, unpleasant previous experience, embarrassment, lack of motivation, and fear of abnormal findings. Forty-one patients identified screening facilitators including (in descending order) recommending during office visits, providing education on different screening options, sending letter reminders, calling patients, utilizing social media, and sending email reminders. Conclusion: The clinical dissertation project increased CRC screening compliance in Elgin, ND, identified barriers, and highlighted screening facilitators that can be utilized. Future projects should focus efforts on alleviating these barriers via targeted patient education and provider recommendation in order to decrease CRC morbidity and mortality.