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Community Event & Education Request Form (H-9)

The City of Milwaukee Health Department is committed to community outreach and education. Each request or event attendance is evaluated on a case-by-case basis. Requests should be made at least 30 days in advance. Requests within a shorter timeframe will be accommodated if possible. Please note: You may be contacted by a designated City of Milwaukee Health Department staff member for further information.

Type of request

 Brochures/Program Materials  Table/Booth (Health Fair/Event)
 Presentation  Testing/Direct Service
 Other: 

Organization


Name of Organization:

Contact Person: 

Address: 

Phone:  

Email:

Type of Organization: 
   Government  Faith-based Organization
   Non-profit  School
   Business Healthcare Organization
   Other:  

Event


Date(s):                         

Time (start and end time):  

Location:

Purpose of event: 
 
Attendees:          
  Number expected: 0-50 50-100 100-200 200-500 500+
  Age ranges (check all that apply):  K-5th grade 6th-12th grade Adults
  Languages (check all that apply): English Spanish Other: 
 
What other community partners are involved?
 
Special instructions for vendor set-up (including set-up time and provided materials): 
 
What amenities will be provided by the event organizers? (check all that apply)
  Wireless internet Tent Tables/Chairs Meals Drinks Other: 
 
Please select up to 5 topics for representation:
  Communicable Disease Newborn Screening
  Domestic Violence Prevention Opioid Prevention & Control
  Emergency Preparedness Safe Sleep
  Food Safety Sexually Transmitted Diseases (including HIV)
  Health Insurance Access & Public Benefits Tattoo & Body Piercing
  Home Environmental Health (Asthma & Mold) Teen Pregnancy Prevention
  Home Visiting WIC (Women, Infants & Children) Program
  Immunizations Women's Health (Breast & Cervical Cancer)
  Lead Poisoning Prevention Other: 
  Men's Health  

 

Please wait while we gather your results.

Health Department Locations


Administrative Offices

Frank P. Zeidler Municipal Building
841 N Broadway, 3rd Floor
Milwaukee, WI 53202-3653
(414) 286-3521

Northwest Health Center

7630 W Mill Rd
(414) 286-8830

Keenan Health Center

3200 N 36th St
(414) 286-8840

Southside Health Center

1639 S 23rd St
(414) 286-8620