Partner Incentive Program Application

Thank you for your interest in partnering with Harris County Public Health through the Vaccine Partner Incentive Program and helping save lives. Once the application is submitted, please allow 10-15 days for processing and response.  

During this process, we expect to receive many applications from many capable non-profit and faith-based organizations. Not all organizations may be selected for this program and some groups will be asked to join our waitlist. 

Please note that the application is meant to be filled out on desktop, laptop, and tablet devices. 

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  • ORGANIZATION INFORMATION

  • ORGANIZATION PRIMARY CONTACT

  • Application Questions

  • 4. If YES, please describe 3-5 most recent service events provided, please be certain to include COVID-19 related activities

    Name of Service

    Brief Description of Service Provided (2-3 sentences)

    Number of People Served

    Description of Community Served (e.g. demographic or zip code served

    Did your org receive external funding (e.g. grant) to support this service? Please select YES or NO