All of Us Mobile Engagement Team Event Request Form

Thank you for your interest in collaborating with the Mobile Engagement Team (MET).

MET visits communities to raise awareness about the All of Us Research Program and provide access to enrollment through on-site devices that serve as mobile enrollment sites. The exhibits features elements for visitors to learn about the benefits of participation and provides an opportunity for interested parties to enroll in the program by creating an account, consenting, and ordering salivary kits on-site.

Collaborations with AoU HPOs:

When visiting an HPO market, NAHH and MET should schedule an initial call to discuss the visit to the market and clarify the purpose of the visit and potential collaborations at least 30 days prior to the visit.

Enrollment URLS:
- If the event location is different from the local enrollment site and if HPO/FQHCs can offer a mobile unit or can set up a pop-up clinic to support PM&B or on-site salivary kit collection, MET team should utilize HPO/FQHCs URL for enrollment
- If only support staff from HPO/FQHC (non-biosamples) can attend MET events, they should utilize MET URL for enrollment (JoinAllofUs.org/onthego).

If HPO/FQHC attends MET events, they agree to encourage participants to order a salivary kit through the participant portal, if the participant is not able or willing to provide PM&B or saliva sample on site or to schedule an appointment with the HPO for later donation.

We recommend that you submit your event opportunity as far in advance as possible, even if all details are not yet finalized.

If you have questions, please contact: Karen Buenrostro, Program Manager kbuenrostro@montagemarketinggroup.com

Name

First NameLast Name

Email

example@example.com

Phone Number

Area CodePhone Number

Name of Organization

Are you an All of Us Research Program Consortium member?

YesNo

If Yes, Select your group

If yes, Name of NIH Engagement Officer or Program Officer:

If CPGI Partner, What is the name of CPGI org that you are affiliated with:

Select the All of Us Journey that you would like to host

How did you hear about the Mobile Engagement Team?

Tell us about the event opportunity:

Is this an existing event?

YesNo

Is your organization the main event host?

YesNo

Event Name

Event Type

Intended Purpose of the Proposed Event:

Expected Event Demographics:

Event Start Date

Date

Event End Date

Date

Event location:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Tell us about the event: goal, expected attendance, promotional efforts, and any other information that can help us understand the opportunity.

Special Request (Interpreters, language needs, etc).

How will you promote the Mobile Engagement Team's visit?