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DHS Office of the Secretary — External Event Request, F-02903 (08/2026)

Thank you for contacting the Department of Health Services, Office of the Secretary. Please complete this form in full to help us understand the type of engagement you are requesting. After submitting the form, you will receive a confirmation email containing your responses. Your request will be reviewed by our team, and someone from our office will contact you once we have determined availability.

1. Are you requesting a meeting or other type of engagement? *This question is required.

Choose the type of engagement you are requesting. *This question is required.

Please enter an 'other' value for this selection. * This question is required.

Please specify the format of the event (e.g., formal remarks, question and answer session, open discussion, panel, etc.). *This question is required.

2. What is the date for this event or requested time for the meeting? *This question is required. If there is not a set date/time, please indicate a preferred date or timeframe.

3. Will this event/meeting be virtual or in-person? *This question is required.

Where will this event/meeting take place? *This question is required.

4. Are you requesting the presence of a specific member of the leadership team? *This question is required.

Indicate whose presence you are requesting. *This question is required.

Secretary
Deputy Secretary
Assistant Deputy Secretary
Legislative Director
Medicaid Director
Public Health Officer
Other (please specify): Please enter an 'other' value for this selection. * This question is required.