COVID-19 Request for Assistance

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This form is for anyone at public health agencies, government bodies, community organizations, private companies and other universities seeking assistance from public health experts at the UIC School of Public Health. Please fill out the form below, and a member of our staff will be in touch as soon as possible.

Name * Required
First Last
Professional Title * Required
Organization or Company * Required
Email * Required
Phone * Required
Your request for assistance * Required
Please be as descriptive as possible. Try to answer the following questions: what information are you requesting? What prompted this request? With whom will the information be shared once provided? By what means will the information be shared once provided? By when is the information needed?

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COVID-19 Request for Assistance

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