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BIPOC COVID-19 Vaccination Clinic Registration
UPDATE 10/29/2021:

PLEASE NOTE that registrations for the BIPOC Clinic has moved to the following link:

OR visit for more information on registration. Thank you!


Vermont Health Equity Initiative is working with the Vermont Professionals of Color Network, Vermont Racial Justice Alliance, New Alpha Missionary Baptist Church, and Black Perspective to coordinate COVID-19 vaccination clinics for BIPOC (Black, Indigenous, Person of Color) individuals and their households.

READ BELOW before proceeding.

Only fill out the form once for your household. Filling out this form more than once will NOT increase your chances of getting an appointment.

Any BIPOC resident of Vermont age 12+ and their household members are eligible for vaccination.

Provide your contact information in the form below and you will be contacted with a vaccination appointment based on the order in which your registration is received.

Clinics are currently located in Burlington. You will be given an exact location when we schedule your appointment.

Privacy Policy: Your data will only be used to coordinate your appointment with the Vermont Department of Health. We will not share your personally identifiable information in any other manner. Please note that the accuracy of the information you provide is critical. All personal data will be deleted at the end of this effort.

If you have any language or access barriers and are unable to complete this form, please call: 802-755-7239
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Town of Residence *
Do you identify as Black, Indigenous, or Person of Color (BIPOC)? This includes anyone who is non-white. *
Who are you filling this form out for? *
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