COVID-19 UPDATE


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Campaign to Get COVID-19 Vaccines Out in Communities of Color

Over 1,200 black and brown people have been vaccinated so far due to this campaign spearheaded by the African American Pastors’ Council.  Thank you for your help.
Let’s keep it going…Join the Community Campaign to Get COVID-19 Vaccines Out in Communities of Color

  1.  See the attached flyers and complete an interest form for yourself and/or someone you know, especially an older person or someone who does not have access to a computer.
  2. Sign-up to volunteer to make phone calls or work on the day of vaccine events.  Email Seirra Winn: smwinn@sentara.com or call 434-984-6220 and leave a message.
  • COVID VACCINE INTEREST FORM

First, Middle, Last Name: ______________________________

Birth Date: ________________________

Address (Not PO Box): __________________________________________

City: _________________ Zip Code: ___________

Gender: ___ Male ___ Female ___ Other: ____________

Race (Check all that apply):

___American Indian/Alaskan Native       ___ Asian         ___ Black or African American

___Hawaiian Native or Other Pacific Islander           ___ White         ___ Other

Are you Hispanic/Latino? ___ Yes       ___ No

Home Phone: __________________    Cell Phone: ___________________

Email address: __________________

What phase are you in?

___ Phase 1A: Frontline Healthcare Workers

___ Phase 1B: Employees of Essential Workers

___ Phase 1B: Individuals Age 65+

___ Phase 1B: Individuals Ages 16-64 with High Risk Medical Conditions

I consent to receive vaccination information or reminders by (Check all that apply):

___ Text Message           ___ Email

Return forms to your church/community organization contact person

Or to:

Sentara Starr Hill Health Center

At the Jefferson School City Center

233 4th Street NW, Second Floor Room 255A

Charlottesville, Virginia 22903

By email to:  Setour Dillard, RN, Integrated Care Manager, sadillar@sentara.com