DSHS Event Planners Outbound Call Campaign Request Form

Event Planners: Please complete one request form per Outbound Call Campaign. You must complete the request at least 3 business days prior to the Vaccine Event.

Region Name (Including Number)

Event Planner Name

Event Planner Email Address

Event Planner Phone Number

What was the original Appointment Slot Type?

NOTE: If you would like to open up your event to the community, change the Appointment Slot Type to "Recipient" to trigger auto-matching. Appointment auto-matching occurs once a day at 8pm CT.

Standard (Closed)
Recipient (would trigger an appointment auto-matching)
Call Center (Open to Call Center only)
Walk-in

What is the purpose of the Outbound Call Campaign you're requesting?

Remind CES-registered recipients about their upcoming appointment
Inform CES-registered recipients of available appointments in their area and attempt to schedule them
Inform non-CES registered recipients of available appointments in their area (Event Planner must provide call list with name, phone number, and language of all recipients when Outbound Call Campaign is approved)
Other, please specify

Name of Event

Date of Event

How many appointments are you trying to fill?

Zip Code(s) to contact

Note: this campaign can include counties/zip codes outside your jurisdiction. Outreach is based on proximity rather than jurisdiction boundaries.

Any Special Requests/Notes to recipients for the calling script?

Any Notes to those managing the Outbound Call Campaign?

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