#Vax2SchoolCT | School COVID Vaccine Clinic Plan Form

The Connecticut Department of Public Health and Connecticut State Department of Education are working to reduce barriers to vaccination across the state, and especially in our schools. Our goal is to plan on-site clinics in August, September, and October at every school in the state with eligible students.
  •  The Department of Public Health encourages all districts to work closely with their local health departments and/or other local vaccination resources to provide these clinics; if you plan to do this, please indicate that below. Griffin Health’s mobile vaccine clinics are available to support this work if other local vaccinators are not available. Please fill out one (1) form per district.
  •  If requesting a Griffin Health Mobile Vaccine Clinic: All responses are thoroughly reviewed, we’ll reach out if we have any questions, you’ll receive an email that your clinic is confirmed, and Griffin Health will connect with you (to discuss logistics, possibly to schedule a site visit, etc). Note: though we seek to provide clinics to all districts, completing this form does not guarantee the availability of a clinic for the days/times requested.
  •  No ID or insurance is required (undocumented students are welcome and invited to receive a vaccine), vaccines will be free to all. At this time, students 12-17 will receive the Pfizer vaccine. Individuals 18+ will be offered a choice of Pfizer, Moderna, or J&J.
  •  Information provided in this form is subject to the Freedom of Information Act.
  •  Questions? Please consult #Vax2SchoolCT: A Toolkit for Connecticut School Districts from DPH + CSDE and/or reach out to DPH.Vax2School@ct.gov
* - Required Field
*
*
*
*
*
*

7. What is your plan to provide a vaccine clinic for your school(s)? *

 We are working with our local health department and/or a local vaccine provider to host vaccine clinics.-
 We are requesting support from the Department of Public Health to provide Griffin Health vaccine clinics.