Vaccine Ambassador Application

Everyone should have access to COVID-19 vaccines and the information needed to make informed decisions. Currently, there are challenges to accessing both information and resources needed to make this vision a reality.

Unfortunately, access to vaccines is not equal for a lot of reasons. Also, some geographic areas have more people who have decided to get the vaccine than others. Some communities are more interested in the vaccine.

Here is some information about vaccinations in our county: https://www.washtenaw.org/3332/Vaccine-Data

If you are interested in becoming a vaccine ambassador, please fill out this short survey. Applications are on a rolling basis but will ideally be received by May 17th.

Questions? Please reach out to Charles Wilson (wilsonc@washtenaw.org) or Adam Paberzs (paberzsa@washtenaw.org).

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Name *
Address *
Phone number *
Email Address *
Why do you want to be a COVID vaccine ambassador? *
What communities and/or groups do you have relationships with that you believe need assistance with getting vaccinated? (These might be neighborhoods, congregations, schools, work communities, online communities, friends and family)? *
Is there any additional support that you would need to more fully participate in this effort (for example, technology support, access to the internet)? *
Do you speak any languages other than English? Do you have other skills, school or life experience that might be useful (e.g., computer, graphics skills, neighborhood organizing)? *
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