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Community COVID-19 Vaccine Clinic Request Form

Community COVID-19 Vaccine Clinic Request Form

The Jackson County Health Department is working with city governments, community organizations, churches, schools, businesses, and event organizers to offer COVID-19 vaccine in the community. Vaccinating the community is the best way to fully re-open Jackson County's economy and protect our most vulnerable. We anticipate a growing need for vaccine distribution beyond mass vaccination sites, and want to make vaccine access as convenient as possible. If you are interested in partnering with the Health Department to offer a COVID-19 vaccine clinic at your site, please complete the interest form. 

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    If you are not affiliated with an organization, please write, "Community Volunteer"
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    The Jackson County Health Department requires at minimum 10 individuals to be identified to receive a vaccine in order to schedule a vaccine clinic.
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    Example: Spanish translation needed at site, clinic needed on weekend, etc.
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    Complete as much information as you know - feel free to leave fields blank. MINIMUM City OR ZIP Code Needed
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