Milwaukee Health Department Coronavirus COVID-19 updates. For assistance, please call the MHD COVID Hotline 414-286-6800

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. Please be as detailed as possible in your requests to best inform the Milwaukee Health Department’s ability to accommodate such requests.

*Required Fields

*Type of request

Please be thorough in your requests and describe specifically what program area you are requesting, any secondary options if the type of request cannot be accommodated, etc.*

Brochures/Program Materials Only 

Table/Booth (ex. Health Fair) 

Presentation/Speaker 

Testing/Direct Service 

Other:  

 

Organization


*Name of Organization:

*Contact Person: 

Address: 

*Phone:   

*Email:

 

*Type of Organization: 

 Government

 Non-profit

 Business

Media

 Faith-based Organization

 School

Healthcare Organization

 Other:  


 

Event Details

*Date(s):                         

*Time (start and end time):   

*Name of location and address:

*Purpose of event: 

*Please also provide brief information to provide targeted population/demographics, goals of event, education versus resources/giveaways, actual services to public, etc.

 

 

*Please select up to 5 topics for representation:

Fatherhood Engagement (DAD Project/Healthy Start)

Community Violence Prevention (Domestic Violence, Suicide Prevention, Youth Violence, Community Violence, etc.)          

Newborn Screening (Hearing and Congenital Disorders)

Emergency Preparedness

Public Health Lab

Food Safety (Consumer Environmental Health)

Safe Sleep

Breastfeeding Education

Childhood Developmental Screening Education

Perinatal Depression Education

Health Insurance, FoodShare and Childcare Access (CHAP)

Sexually Transmitted Diseases (including HIV)

Environmental Health (e.g. rabies, mold) 

Home Environmental Health (Lead intervention)

Tattoo & Body Piercing

Home Visiting - maternal

Home Visiting - paternal 

Doulas

Immunizations

WIC (Women, Infants & Children) Program

Lead Poisoning Prevention

Women's Health (Breast & Cervical Cancer)

Lead & Water

Other 

 



*Is media invited to the event?

Yes    No    Unsure

If yes, please describe media organization/POC. 



Additional Event Information

Attendees: 

Number expected:

0-50

50-100

100-200

200-500

500+

 

Age ranges (check all that apply): 

Infants & Toddlers

K-5th grade

6th-12th grade

Adults

 

Languages (check all that apply):

English

Spanish

Other: 

Additional information about event target population (teen mothers, high school youth, male/father figures, etc.):

What other community partners are involved?

Special instructions for vendor set-up (including set-up time and provided materials): 

Does vendor have COVID-19 precautions in place (face mask wearing, temperature screening, vaccine or negative test proof mandates, social distancing, etc.)?

 Yes          No         Not Sure

What amenities will be provided by the event organizers? (check all that apply)

Wireless internet

Tent

Tables/Chairs

Meals

Drinks

Other: 

 

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