Department of Public Health - Request for Participation
Cleveland Department of Public Health (CDPH) - Request for Participation


The Cleveland department of Public Health (CDPH) is excited for the opportunity to work with your organization. Please complete the following form/fields with as much detail as possible. A staff member will follow-up within three business days.

All questions with an asterisk (*) are required.

Contact Person:

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Event Information:

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Address (numeric only):
Street Direction:
Street Name:
Street Type:




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Set both dates with same date for one day events:

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Type of Participation:
Provide Literature
Table/Booth
Medical Screenings
Services Related to COVID-19
Presentation/Speaker
Other

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