Expression of Interest in Joining the HealthWorks Small Business Health Ambassador Program

What is HealthWorks?

HealthWorks is an initiative funded by the U.S. Department of Health and Human Services to increase COVID-19 vaccine confidence and uptake. The HealthWorks project is led by Morehouse School of Medicine, Meharry Medical College, and ASHLIN Management Group. Minority-owned businesses in Georgia and Tennessee are invited to join the HealthWorks program to learn how they can enhance their company’s resilience against COVID-19.

Businesses that complete the HealthWorks program will be eligible to receive up to $2,000 in incentives and will be promoted as business community leaders through HealthWorks social media posts and other channels.

Please enter your business's information below if you are interested in participating in the HealthWorks program. For more information please visit www.ashlininc.com/healthworks.

*Mobile Device Users- Click the Blue arrow button in the bottom right corner of your screen to complete the survey.

1. First Name: *This question is required.

2. Last Name: *This question is required.

3. Enter your email address: *This question is required. This question requires a valid email address.

4. Phone Number

5. Name of Organization Interested in Joining HealthWorks: *This question is required.

6. City: *This question is required.

7. State: *This question is required.

8. Number of employees, including owner(s): *This question is required.

9. Industry:

10. Would you like to refer another minority-owned business that has at least two employees, and operates in Georgia or Tennessee? Please enter the referred business's Point of Contacts Name, email, and/or phone number here.

11. How did you find out about the HealthWorks program?

12. Other, please specify:

For more information about the HealthWorks Program, please visit www.ashlininc.com/healthworks/ .