To build upon the tremendous work that has been completed by providers to date, the Pennsylvania Department of Health is offering support to community groups, faith-based organizations, schools, state agencies, businesses, employers, and any other groups interested in working with COVID-19 vaccine providers to perform community vaccination clinics.
Please fill this form out if you are:
A community group, faith-based organization, school, state agency, business, employer, or other group willing to organize a vaccination clinic for your membership
An enrolled COVID-19 vaccine provider willing to facilitate onsite vaccination clinics at community locations identified by community groups, faith-based organizations, or other groups
Clinic hosts are expected to help mobilize their community, advertise the event, and ensure there is enough interest to hold a clinic. For your convenience, the Vaccine Outreach Toolkit can be found here: https://www.pa.gov/covid/download/vaccine-outreach-toolkit/?wpdmdl=2233.
Please note - this is not an approval process, only an opportunity to streamline the partnering process for those that have not been able to find a provider. Partnerships can occur outside of this form and do not require DOH approval to proceed.
PA DOH will work to match clinic hosts with vaccine providers but filling out this form is not a guarantee of an appropriate match.
Responses to this form will be evaluated on a rolling basis, and PA DOH will attempt to respond within a week of receiving requests. Any questions can be directed to the Resource Account at RA-DHCOVIDVAX@PA.GOV