Community Outreach Support and Resources Request Form


The Minnesota Department of Human Services (DHS) is eager to collaborate with community partners to ensure successful health insurance renewals for Minnesotans. We offer support for events, a variety of communication materials, and numerous additional resources to aid your efforts. If you're planning an outreach activity or need assistance related to Medical Assistance and MinnesotaCare renewals, please fill out this form with your request. Your partnership enables us to extend our reach and impact, ensuring no one misses the opportunity to renew their coverage.

 

Please enter your contact information:

 
 

Please specify the name of the organization or group you represent.

 
 
Phone
 


Select Your Request Type: Choose the appropriate option to indicate the nature of your submission.


If you are requesting resources, materials, or support for an event, select "Resource Request".


If you are looking to promote an upcoming event on our Public Calendar without requesting additional resources, choose "Event Promotion Only".


If you are grantee reporting on outreach activities, select "Grantee Reporting".


This will help us process your request efficiently and ensure it is directed to the right team.

 

Name of the outreach event or activity.


Example: DHS Renew My Coverage Webinar

 

Date event will take place.

Note: If a date has not been set, please keep this section blank.

 
mm/dd/yyyy
 

Please provide a brief description of this outreach activity and the technical assistance you are requesting.

 
 
 

Who is the audience your outreach activity is trying to reach? Who will be the participants of this activity or event? Please specify:

 
 

Please provide any other details or specific requests.


Please note that any additional details you provide here will be displayed on the public events calendar if that option has been selected.