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The Adopt-a-School Vaccination Program

The Mississippi State Department of Health invites health care providers in the state to participate in the Novel H1N1 Influenza Vaccine Adopt-a-School Program.

The Adopt-a-School program will help to ensure that school-age children throughout the state have the opportunity to receive the novel H1N1 influenza vaccine. The goal of the Adopt-a-School program is to reduce the incidence of this new virus among school-age children throughout Mississippi.

How to Participate

You are encouraged to participate in the vaccination of children in a school or schools in your community for novel H1N1 influenza. Vaccine, vaccine information sheets, consent forms and a letter to parents will be provided to you, free of charge after enrollment in the program. A small stipend of $5 will be available per vaccine dose given, to mitigate the cost to your office. Providers who adopt a school will work as contractors to MSDH and will be covered by the State's liability protection. Download enrollment forms below.

Duties

Healthcare providers who agree to assist MSDH in this vaccination effort will collaborate with the school administration to determine the best way to vaccinate children in their school. MSDH will provide the appropriate paperwork for the school to disseminate to parents. The healthcare provider will order an appropriate amount of vaccine and administer it to students whose parents consent, and to teachers and staff who are in the CDC priority groups.

While adopting a school will require time and energy, the impact of your efforts will make it worthwhile. If you cannot commit to the full Adopt-a-School program, please consider volunteering through our VIPR disaster volunteer registry. Volunteers are needed to assist local health departments at vaccination clinics they will run at schools that are not adopted.

More Information

If you should have questions or need additional information, contact the Immunization Program staff at (601) 576-7751.

 
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  Adopt-a-School Instructions for Enrollment    download    pdf [105KB]
  Adopt-a-School Enrollment Form    download    pdf [7KB]
  Adopt-a-School Physician Services Agreement    download    pdf [93KB]
  Adopt-a-School Physician Services Agreement - Sample    download    pdf [93KB]
  Adopt-a-School Minority Vendor Certification    download    pdf [250KB]
  Form W-9    download    pdf [250KB]
  MIIX User Agreement Form
  MSDH District Offices
Contact information for each public health district in the state
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