AMEC International Health Commission COVID-19 Vaccine Distribution and Medical Personnel Services for Administering the Vaccine Survey

The AMEC International Health Commission is joining a collaborative that is proposing to provide medical personnel services to administer the COVID-19 vaccination throughout the United States and its Territories. We are hoping that this model can also be used across the Connection.

Personnel needed for these services are not limited to doctors, nurses, or phlebotomist but to all healthcare professionals that are certified to administer the COVID-19 vaccine.

1.Demographics

Name

Health Commission Title, if appropriate

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

2.Do you belong to the African Methodist Episcopal Church?

Yes

No, please place your affiliation or agency in "Other"

Other (please specify)

3.AME Church Information

Name of Church

Episcopal District

Presiding Elder District

Address Line 1

Address Line 2

City/Town

State/Province

Zip/Postal Code

Country

Website

Telephone Number

6.Are you certified to administer a COVID-10 vaccine?

Yes, by profession (physicians)

Yes, by certification training (indicate under "Other" the certifying body)

No. I am eligible and willing to be trained and certified

No. I am not eligible but am willing to provide administrative support

Other (please specify the certifying body)

8.Can you be available within twenty-four (24) hours to each identified location?

Other (please specify)

AMEC International Health Commission COVID-19 Vaccine Distribution and Medical Personnel Services for Administering the Vaccine

Medical personnel and administrative support services for administering COVID19 vaccine