Request to participate in an activity.

Please complete the form below to submit your request for consideration.
Requests must align with and support the promotion of access to health, health education, and foster community engagement. Generally, a request must meet the following guidelines: 

• 60-day notice for health fairs, cultural events, and festivals 
• 90-day notice for health awareness campaigns 

Note: Consideration may be given in special circumstances for events with shorter notice
After You Submit this Form
Email questions or any supplemental material to communityengagement@eriefamilyhealth.org. A response will be provided within 7-10 business days.

Question Title

* 1. What is the name of the organization making the request?

Question Title

* 2. What is the name of a good contact person at this organization?

Question Title

* 3. What is their email address?

Question Title

* 4. Please list the organization address here.

Question Title

* 5. Please list the organization's phone number.

Question Title

* 6. What is the organization's website?

Question Title

* 7. Type of event

Question Title

* 8. Please describe the event, and state its purpose here.

Question Title

* 9. What is the deadline for participation?

Question Title

* 10. What is the format for this event?

Question Title

* 11. What is the type of audience for this event?

Question Title

* 12. Is this event open to the public?

Question Title

* 13. Can we publicize this event?

Question Title

* 14. What are the virtual platform(s) for the event?

Question Title

* 15. What are your social media handles and hashtags for this event?

Question Title

* 16. Please tell us any additional information about this event.

Question Title

* 17. Who is your main contact at Erie Family Health Centers?

0 of 17 answered
 

T