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.
*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)
*Name of Organization:
*Type of Organization:
*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)
Public Health Lab
Food Safety (Consumer Environmental Health)
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
WIC (Women, Infants & Children) Program
Lead Poisoning Prevention
Women's Health (Breast & Cervical Cancer)
Lead & Water
*Is media invited to the event?
Yes No Unsure
If yes, please describe media organization/POC.
Additional Event Information
Age ranges (check all that apply):
Infants & Toddlers
Languages (check all that apply):
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)