#Vax2SchoolCT | School COVID-19 Vaccine Clinic Plan Form (Ages 5-11)

The Connecticut Department of Public Health (DPH) and Connecticut State Department of Education (CSDE) are working to make sure that individuals across the State of Connecticut are able to easily access COVID-19 vaccines. As in the vaccine roll-out for students ages 12+, DPH and CSDE want to facilitate on-site vaccine clinics available at elementary and middle schools with students ages 5-11 in the coming months.

You will be able to either work with your local health department, a vaccine provider with whom you have a relationship, or request support from DPH through a mobile van for your school-based vaccination clinic. Please note that, if your school has a school-based health center, your primary channel for vaccinating students should be your school-based health center. If you need supplemental support, you are welcome to request a clinic below.

School Leaders: Please fill out one form per school. If desired, superintendents or district leaders may complete the below form on behalf of all schools in their district. Please ensure that individual school leaders and district leaders do not submit duplicative responses.

Note that at this time, students ages 5-11 will receive the pediatric Pfizer COVID-19 vaccine, which is a two-dose vaccine. As such, schools will be expected to host both a first-dose and a second-dose clinic (3 weeks following the first clinic). No ID or insurance is required, and vaccines are free to all.

Questions? Please consult the updated #Vax2SchoolCT: A Toolkit for Connecticut School Districts from DPH + CSDE or reach out to DPH.Vax2School@ct.gov.

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Primary contact for scheduling/logistics
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What is your plan to provide a vaccine clinic or clinics for your school / district? Note: If you are a superintendent or district leader and want to request support from DPH to provide vaccine clinics (Option 4 below) at multiple schools in your district, you will need to complete separate surveys for each school. If you plan to request clinics at >5 schools, please email DPH.Vax2School@ct.gov for support. *

 We already have a plan to work with our local health department and/or a local vaccine provider to host a vaccine clinic or clinics and do not need additional support
 We will offer COVID-19 vaccines through our school-based vaccine clinic and do not need additional support
 We do not need an on-site vaccine clinic because we do not anticipate demand, e.g >90% of students will receive COVID-19 vaccines in the community
 We are requesting support from the Department of Public Health to provide a vaccine clinic (i.e. select this option to request a DPH van and enter details below)
 Other