Department of Health
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Department of Health and Human Services

Community Event Request

Baltimore County Department of Health and Human Services
6401 York Road, Third Floor
Baltimore, Maryland 21212-2130

Phone: 410-887-1HHS (1447)
TTY users call via Maryland Relay

Thank you for your interest in having programs and staff from Baltimore County Department of Health and Human Services participate in your upcoming event. If your event is within the next four to eight weeks, please completely fill out the form below. If your event is later in the year, please return to complete the form closer to the event date. If you do not have Internet access, call 410-887-8467 for assistance.

All requests are reviewed once received. Please note our ability to honor your request is based on staffing, date and target audience. The form only acts as a notification to the appropriate person or programs to request their participation.

Fields marked with * are required.
Contact Person Information
Sponsoring Organization Information
The Event Will Be Held (check all that apply)
Table and Chairs Supplied
Fee to Participate
Fields marked with * are required.
Areas of Interest
Adult Foster Care Recruitment (Project Home)
Behavior Health (mental health and substance abuse)
Cancer Programs (breast, cervical, colon)
Dental Health
Domestic Violence
Emergency Preparedness
Family Planning
Financial Services
Food Safety and Proper Food Handling
Handwashing and Universal Precautions
HIV/AIDS/STI (resources only)
HIV/AIDS (testing – requires two private rooms)
Lead Paint Poisoning Prevention
Medical Assistance Programs (healthcare coverage)
Pregnancy and Early Childhood
Professional Recruitment (check all that apply)
Reporting Abuse and Neglect (check all that apply)
Resource Parenting (Foster Parenting and Adoption Services)
Services for Seniors
Use of Tobacco and Tobacco Cessation
Tobacco Cessation
Women, Infants and Children Program (WIC)

Revised September 24, 2015

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