Community Outreach Event Request

Thank you for your interest in partnering with the Department of Health and Human Services for your upcoming event. The Department can provide table displays, educational materials, or various health screenings for your event that support our mission to ensure safe communities, promote smarter development and improve County services. If you need assistance filling out this form call 410-887-8918.

Request Process

Complete the online request form below. A separate form should be completed for each event. Provide as much notice as possible, as later requests may affect our ability to attend. Allow five County business days for a response.

We may be unable to fulfill every request, even if the organization meets the above criteria. Baltimore County Health Department is unable to provide sponsorship, grant or advertising requests. If you are requesting a speaker for an event, do not complete this form. Instead, email hhscommoutreach@baltimorecountymd.gov.

Fields marked with an asterisk are required.

YOUR CONTACT INFORMATION

Name

First Name

Last Name

Phone Number

Organization Sponsoring Event

Event Address

Address

ZIP Code

Event Date

Response Deadline

Event Set-up Time

Event Start Time

Event End Time

Number of Attendees Expected

Targeted Audience (Include primary language of audience)

How will the event be held? (Check all that apply.)

Rain Date

Will tables and chairs be supplied?

Yes

Brief Description of the Event

Is there a fee to participate?

Yes

Areas of Interest

Questions	Information Only	Program Representative
Adult Foster Care Recruitment (Project Home)	Information Only	Program Representative
Behavior Health (Mental health, substance abuse and overdose prevention)	Information Only	Program Representative
Cancer Programs (Breast, cervical and colon)	Information Only	Program Representative
Childhood Lead Poisoning and Asthma Program	Information Only	Program Representative
Chronic Disease	Information Only	Program Representative
Dental Health A program representative is not available for this option, which is information only. Please select the information only option.	Information Only	Program Representative
Domestic Violence	Information Only	Program Representative
Emergency Preparedness	Information Only	Program Representative
Emerging Infection Disease Program	Information Only	Program Representative
Family Planning	Information Only	Program Representative
Financial Services—Food Stamps	Information Only	Program Representative
Financial Services—Medical	Information Only	Program Representative
Financial Services—Cash	Information Only	Program Representative
Financial Services—Energy	Information Only	Program Representative
Harm Reduction	Information Only	Program Representative
Hepatitis C Program	Information Only	Program Representative
HIV/AIDS/STI Resources	Information Only	Program Representative
HIV Prevention and PrEP Navigation	Information Only	Program Representative
HIV Testing This program requires two private rooms or request of the Mobile Unit	Information Only	Program Representative
Immunizations	Information Only	Program Representative
Medical Assistance Programs (Healthcare coverage)	Information Only	Program Representative
Mobile Outreach (MO) Unit If you would like COVID-19 information, select the checkbox at the bottom of this form.	Information Only	Program Representative
Pregnancy and Early Childhood	Information Only	Program Representative
Reporting Abuse and Neglect—Adult Abuse	Information Only	Program Representative
Reporting Abuse and Neglect—Child Abuse	Information Only	Program Representative
Resource Parenting (Foster Parenting and Adoption Services)	Information Only	Program Representative
Services for Seniors	Information Only	Program Representative
Use of Tobacco and Tobacco Cessation	Information Only	Program Representative
Women, Infants and Children Program (WIC)	Information Only	Program Representative

If Mobile Outreach Unit was selected, did you want to receive COVID-19 information?

Yes

Can two, separate rooms be made available?

Yes

Contact Us

Department of Health

6401 York Road, Third Floor
Baltimore, Maryland 21212

Hours

Monday through Friday
8:30 a.m. to 4:30 p.m.

Email

hhs@baltimorecountymd.gov

Health

410-887-2243

TTY

711

Deputy Health Officer

Della Leister

Deputy Director of Finance and Administration

Lawrence Richardson

Request Contact

Submit a contact request.