Application for Community Organizations Distribution

Thank you for your interest in distributing COVID-19 rapid at-home testing kits to the residents of New Castle County. We appreciate your partnership in reaching community members via your network. Ensuring equitable distribution of these resources is an important part of the county’s strategy to battle the ongoing pandemic.

Please enter the requested details below so that we can coordinate requested tests across the county. A member of the Test Kit Distribution team will be back in touch after your reviewing your request.

Contact Information

First Name

Last Name

Organization

Position or Title

Address 1

Address 2

City

State

Zip Code

County

Email

Confirm Email

Phone Number

Input Organization's Mission Statement (Max 2000)

Are you a registered 501c3?

Yes

No

Do you primarily serve residents of New Castle County?

Yes

No

How many residents do you serve?

How many staff members do you have?

Project/Initiative/Event Title:

How many rapid tests are you requesting?

What is your plan to distribute rapid tests to the public? (Max 2000)

New Castle County will advertise your rapid test distribution event(s). What is the date(s) and time(s) you plan to distribute?

Date/Time1	Date/Time2	Date/Time3	Date/Time4	Date/Time5	Date/Time6

Are there any New Castle County Employees associated with your organization?

Yes

No

Is there any other information you would like to share with us? (Max 2000)

I certify that the statements and information submitted herein are true to the best of my knowledge and grant permission for the information contained herein to be shared with the test kit distribution committee.

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Rapid Test

Contact Information