For family and community facing events hosted by partners. Please submit this form at least two weeks prior to the event if you want MomsFirst CDPH to post on social media and/or help at the event; at least 48 hours before the event if you are just letting MomsFirst CDPH know of the event.

Partner Information

Site Name

Contact Person

Phone Number

Event Details

Event Type

Open to Public?

Can CDPH share with other partner agencies, funders, organizations, social media etc.

Date of Event

YYYY

Start and End Time of Event

i.e. 4:30 pm - 6:00 pm

Location

Event Description

Brief Overview

2-3 sentences summarizing the purpose

Target Audience

expecting moms/dads, families, youth, community members

Key Activities or Topics Covered

e.g., health screenings, resource distribution, workshops

Registration

Is Registration Required

Registration Link or Contact Information for RSVP

Is Assistance Needed From MomsFirst?

Cleveland Department of Health Mobile Health Unit #1

Would you like to request the Cleveland Department of Health Mobile Health Unit #1

This may or may not be available. The earlier this form is submitted, the better the chances. A staff member will follow-up with you to confirm.

If requesting the Mobile Health Unit #1, please check off the type of participation you would be interested in the unit providing

check all that apply

Provide Educational Materials/Resources

Table/Booth

Blood Pressure Screenings

STI (urine based) Screenings

Pregnancy Test

Family Planning Consultations

Immunizations

Presentation/Speaker

MomsFirst is an Initiative of the Health Equity and Social Justice Division at the Cleveland Department of Public Health

We are committed to improving the quality of life in the City of Cleveland by promoting healthy behavior, protecting the environment, preventing disease, and making the city a healthy place to live, work and visit.

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