Trusted Messenger Interest Form

  • Trusted Messenger Interest Form

    Adult Vaccination REACH Program
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  • Thank you for your interest in volunteering to become a Trusted Messenger for our Adult Vaccination initiative! 

    Trusted Messengers work to:

    • Assist with dispelling myths about vaccines and the viruses
    • Help with upcoming event planning
    • Attend events if possible
    • Shares updates and event information in their community circles
    • Attend quarterly meetings to discuss updates and events and provide feedback
    • Are encouraged to recruit additional messengers

    Please answer the following questions about the position, and we will be in touch with the next steps. 

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  • Gender

  • Please take or upload a picture of yourself for your Trusted Messenger Profile. 

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  • What is your race or ethnic background?

  • What kind of Trusted Messengers can you be? (Please select all that apply)

  • Are you able to join our Trusted Messenger committee meetings every fourth Thursday of the month?
  • Which of the following vaccines do you feel comfortable talking about or providing information on?
  • Which social media platforms do you use for learning or communication? Check all that apply.*

  • How frequently do you use social media?
  • Should be Empty: