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 1 month prior to the date of your event.

Please type the title of your event

Do you have a flyer for your event?*
Drag and drop files here or

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

What other organizations are anticipated to attend? What type of activities/initiatives are involved?

Do you have an application for this event?*

Is there a registration fee?*

Select all that apply

Select
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In-Person
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Please select from the choices below.

Select
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No
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Role of Department of Health in Seminole County

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.

Select
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Select all that apply


Please CLICK HERE for a description of our programs and services.

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

Event Point of Contact

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

Event Details

Event Location

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

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

Event Preparation

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.

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