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KY Agencies \| KY Services Jump to Page Content. Secondary Menu About CHFS \| Contact Us \| Forms and Documents
Jump to Page Content. Home Entry New Entry Logging Items A Matter of Balance Instructor Registry Arthritis Program Bingocize Certification Board of Health Nominations Boards and Commissions Application Breast Cancer Research/Education Trust Fund CHFS Boards and Commissions Application Chronic Disease Self-Management Program Coordinated School Health Team Registration COVID-19 KY Lab Daily Report Access Request Cultural Competency Questionnaire DAIL Suggestions DCBS Family Satisfaction DCBS Process Modernization Survey Diabetes Class Survey Eleventh Grade Immunization Survey First Steps EOB Foster Youth Exit Survey Health Facility Petition K-12 COVID-19 School Self-Reporting Access Request Kentucky Abortion-Inducing Drug Complaint Portal Kentucky Health Promotion Program Kentucky Radon Test Request Form KHIE Input For EHR Kindergarten Immunization Survey KY COVID-19 Community Outreach Events KY Diabetes Peer-Led Self-Management Program Application Local Health Personnel Training MCO Information Packet Requests OHRM - Training Survey OLD Exit Interview for Separating Employees Osteoporosis Program- Local Health Department PASSR Training Physical Disability Services Satisfaction Survey SAMHSA Grant Kickoff Meeting Seventh Grade Immunization Survey SUID Investigation Training Registration TBI	Page Content KY COVID-19 Community Outreach Events Logging Welcome For any community outreach event hosted by or in partnership with your COVID-19 Vaccination Facility, please provide the following information. Event Information Date of event: Required Field Invalid entry format Facility Name (Vaccination Partner) Required Field Location of Event Street Address: Required Field City: Required Field Zip Code: Required Field Invalid entry format Event County # of Doses to be Administered: Required Field Event Description: Exceeding 8000 charactersRequired Field Contact Information First Name Required Field Last Name Required Field Email Required Field Invalid entry format Phone Number *Required Field Invalid entry format Upload Instructions If you would like to upload event flyers or other event details, after you click SUBMIT, scroll down and click UPLOAD DOCUMENT to attach an image or document. Jump to Site Menu
Contact Us \| CHFS Site Map Privacy \| Disclaimer \| Individuals with Disabilities Copyright © 2009 Commonwealth of Kentucky All rights reserved.

KY Agencies \| KY Services Jump to Page Content. Secondary Menu About CHFS \| Contact Us \| Forms and Documents
Jump to Page Content. Home Entry New Entry Logging Items A Matter of Balance Instructor Registry Arthritis Program Bingocize Certification Board of Health Nominations Boards and Commissions Application Breast Cancer Research/Education Trust Fund CHFS Boards and Commissions Application Chronic Disease Self-Management Program Coordinated School Health Team Registration COVID-19 KY Lab Daily Report Access Request Cultural Competency Questionnaire DAIL Suggestions DCBS Family Satisfaction DCBS Process Modernization Survey Diabetes Class Survey Eleventh Grade Immunization Survey First Steps EOB Foster Youth Exit Survey Health Facility Petition K-12 COVID-19 School Self-Reporting Access Request Kentucky Abortion-Inducing Drug Complaint Portal Kentucky Health Promotion Program Kentucky Radon Test Request Form KHIE Input For EHR Kindergarten Immunization Survey KY COVID-19 Community Outreach Events KY Diabetes Peer-Led Self-Management Program Application Local Health Personnel Training MCO Information Packet Requests OHRM - Training Survey OLD Exit Interview for Separating Employees Osteoporosis Program- Local Health Department PASSR Training Physical Disability Services Satisfaction Survey SAMHSA Grant Kickoff Meeting Seventh Grade Immunization Survey SUID Investigation Training Registration TBI	Page Content KY COVID-19 Community Outreach Events Logging Welcome For any community outreach event hosted by or in partnership with your COVID-19 Vaccination Facility, please provide the following information. Event Information Date of event: Required Field Invalid entry format Facility Name (Vaccination Partner) Required Field Location of Event Street Address: Required Field City: Required Field Zip Code: Required Field Invalid entry format Event County # of Doses to be Administered: Required Field Event Description: Exceeding 8000 charactersRequired Field Contact Information First Name Required Field Last Name Required Field Email Required Field Invalid entry format Phone Number *Required Field Invalid entry format Upload Instructions If you would like to upload event flyers or other event details, after you click SUBMIT, scroll down and click UPLOAD DOCUMENT to attach an image or document. Jump to Site Menu
Contact Us \| CHFS Site Map Privacy \| Disclaimer \| Individuals with Disabilities Copyright © 2009 Commonwealth of Kentucky All rights reserved.

For any community outreach event hosted by or in partnership with your COVID-19 Vaccination Facility, please provide the following information.

If you would like to upload event flyers or other event details, after you click SUBMIT, scroll down and click UPLOAD DOCUMENT to attach an image or document.