• Services Request *
  • Directions

    Please fill out all required information (a red asterisk will indicate). Scroll down to see each service the EWD branch has to offer. The services will be titled with their own instructions underneath each title. Please read the instructions before sending the form.

  • **IMPORTANT NOTICE REGARDING TECHNICAL ASSISTANCE!!

    **If technical assistance is needed you will be required to make arrangements at least 5 business days in advance with the CommonwealthServiceDesk@ky.gov. The EWD Branch is not responsible for providing technical assistance or contacting them. **Effective May 1, 2014, in accordance with COT Infrastructure Initiative (I.3) fees may be assessed for technical assistance. Please direct questions regarding these fees and their applicability to COT by calling 502-564-7576 or by email at CommonwealthServiceDesk@ky.gov.

  • Today's Date*
  • Email Address*
  • Contact Name *
  • Phone Number*
  • Department of Public Health Branch*
  • If Other, Please Specifiy
  • Title of Course*
  • Brief Description of Event/Course *
  • Recurring Program (module request n/a)
  • Date/Dates of the Event*
  • Start Time of the Event (EST)*
  • End Time of Event (EST)*
  • Specific Request Needed
  • Estimated Attendance
  • Equipment Needed
  • **Please contact CotVideoConferencing@ky.gov to obtain a Meeting Room Number (MR#)

  • IMPORTANT NOTICE REGARDING TECHNICAL ASSISTANCE!!

    *If technical assistance is needed you will be required to make arrangements at least 5 business days in advance with the CommonwealthServiceDesk@ky.gov. The EWD Branch is not responsible for providing technical assistance or contacting them. **Effective May 1, 2014, in accordance with COT Infrastructure Initiative (I.3) fees may be assessed for technical assistance. Please direct questions regarding these fees and their applicability to COT by calling 502-564-7576 or by email at CommonwealthServiceDesk@ky.gov.

  • Will the program be on TRAIN?
  • Will you need this program recorded and/or webcasted?
  • Subject Matter/Content Expert
  • Module Description
  • Estimated Completion Date
  • Directions

    Attention: Videographer will arrive at the location 30 minutes to 1 hour prior to the time of the event to setup. Persons being videotaped need to sign a release form. If minors are to appear in the video, their parents/legal guardian must sign the Minor Release Form. *Requester must have a script developed prior to taping. The videographer can assist in the development of video scripts. Please contact chfs.ewd@ky.gov for assistance.

  • Contact Person at the event (if different than Contact Person)
  • Location of Taping
  • Title of Taping
  • Type of Taping
  • If other, please specify
  • Final Product will be:
  • Time
  •