Outreach Request Form for the Florida Department of Health in Seminole County

To request the Florida Department of Health in Seminole County's participation in a health fair/community event, please complete this form. Submission of this form does not guarantee participation in your upcoming event. Participation is based on staff availability and focus areas.


To ensure a smooth and timely process, kindly submit your request at least 2 weeks prior to the date of your event.

Please type the title of your event

Please provide a short description of your event. (Max: 60 words)

Phone

If your office phone number has an extension please enter it here. If you do not have an extension leave this question blank.

Phone

Please provide the name of the building or important location details. (Ex. Fort Mellon Park)

Please provide the street. (Ex: 400 W. Airport Blvd)

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Select all that apply


Please CLICK HERE for a description of our services.


Please Note: "Literature/Brochure only request" means we will drop off literature/brochures for your event but will not have our staff attend.

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Will you provide our staff with 2 private rooms/spaces where we can conduct the testing and pre-testing counseling??*

Select all that apply

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Is the event inside or outside?*
Will shade be provided?*
Will your organization provide tables and chairs?*

Enter the number of chairs your organization can provide for our use.

Enter the number of tables your organization can provide for our use.

Do you have an application for this event?*

Is there a registration fee?*
Do you have a flyer for your event?*

Please select from the choices below.

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