Seneca County, OH Tier 1A Scheduling List
If your organization is in the State of Ohio Prioritization List, please complete this form to be placed on our vaccination scheduling list. As we receive more doses, we will work with you to inform you of the location, time and method of registration for your staff. At this time, we do not have exact dates and timeframes because it all hinges on when and how much vaccine we receive from the state. Once more information becomes available you will be notified so please be patient. Please do not submit your information more than once. You can view the priority list on this document: https://coronavirus.ohio.gov/static/vaccine/general_fact_sheet.pdf.
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Provider Type *
Agency/Organization Name *
Address *
Estimated Number of Staff to Receive Vaccination *
Contact Name *
Contact Phone Number *
Contact Email
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