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COVID-19
Apply to Host a Community Vaccination Event
Thank you for your interest in hosting a COVID-19 vaccination event in your community! Please complete the information below.
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Name of Vaccination Site
*
Address of Vaccination Site
*
County
*
Contact Person for Vaccination Event
*
First
Last
Contact Phone Number
*
Contact Email
*
Vaccination for community or an organization?
*
Community
Vulnerable Population (i.e. homeless, non English speaking, etc)
Church Congregation
Other
If you chose "Other" above, please explain.
Estimated number of people to be vaccinated
*
1-10
10-25
More than 25
If more than 25, please provide your best guess below.
Does the location have capacity to host a drive through vaccination event?
*
Yes
No
Does the location have the capacity to host an indoor vaccination event?
*
Yes
No
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Schedule a VACCINE Appointment
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