IDPH Community Ambassadors Program: Sign-up Form

Thank you for your interest in becoming an IDPH Community Ambassador!


The IDPH Community Ambassadors Program empowers Illinoisans to support state public health efforts. Originally launched as the IL COVID-19 Ambassadors Program, it focused on spreading evidence-based information to curb the pandemic. Ambassadors shared prevention, testing, vaccination, and other health resources within their communities.


Now, the program addresses emerging public health issues, including MPV, women's health, violence, and more. Working with local health departments and community groups across the state, Ambassadors help build community support networks and stay informed on regional health developments.


Fill out the Sign-up Form to apply!

Contact Information

Phone
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More About You

Help us get to know you.

Please specify the racial/ethnic subgroup(s) you belong to. For example, if you selected "Asian" in the last question, a possible response here could be Pakistani-American.

Please select your primary language:

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Please select a secondary language (if applicable)

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Please select other languages (if applicable):

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Are you available to assist with translations? Examples of potential translation needs include newsletters, program flyers, online content, and other publications.

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Gender*

(Note: terminology adopted from the National Institutes of Health (NIH))

For example, you can say "college student, member of a religious organization...etc)

Program Interest

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By selecting the checkbox below, you consent to receive regular communications from the program administrators, including emails, calendar invitations, newsletters, and other updates, throughout your tenure as a Community Ambassador.

Thank You for Signing Up!

Thank you for your interest in our program! A program administrator will send you a confirmation e-mail upon review of your form. If you have questions about the form or the program, please send an e-mail to: DPH.AmbassadorsProgram@illinois.gov.

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