Sexual Health Outreach Request Form

Please complete this form to request participation, a presentation, and/or materials from the Erie County Department of Health Sexual Health Outreach Team.

If you would like additional information, or have any questions, please contact us at SexualHealthOutreach@erie.gov.

Please note that submission of this form does not confirm that we will be able to fulfill your request.

* Fields with an asterisk (*) are required fields.

School/Organization/Business/Event Name

School/Organization/Business/Event Address

City/Town

State

ZIP Code

Contact First Name

Contact Last Name

Contact Phone

Contact Email

Confirm Email

Please select what best describes what you are looking for (select all that apply)

Sexual Health Education (General)

VOICES/VOCES Workshop

Testing Event

Materials request

Other…

Please specify what materials you would like.

Approximate number of participants

Please describe the target audience for your event (Ex: Students, Seniors, Worksite, etc.)

Please provide us with a brief description of what you are looking for.