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NYC Vaccine Referral Bonus

Organization Application Form

On June 14, Mayor De Blasio announced the NYC Vaccine Referral Bonus—New York City’s latest initiative to encourage New Yorkers to receive the safe and effective COVID-19 vaccine. The City is making up to $4,000,000 of direct payments available to civic, faith, tenant and other associations for referring their community members to receive the vaccine.

The City is seeking civic groups to perform outreach to encourage New Yorkers to get vaccinated. Approved organizations will receive $100 for every individual they refer that receives their first vaccine dose at a City-run vaccination site. Organizations will be able to earn up to $20,000 (i.e. 200 referrals).

Once an organization is approved for participation in the program, individuals making appointments or walking up to City-run vaccine sites will be able to select their referring organization. The individual must receive their first dose in order for the organization to receive credit. No personal information for those getting their shots will be shared with the organization. Payment will be made to organizations after the program concludes.

Application and Selection Criteria

In order to apply for the program, organizations must fill out the form below. This interest form will be reviewed for eligibility based on: 1) Demonstrated experience working in low-income neighborhoods and/or with marginalized communities providing services or benefits, community organizing, conducting community education or other civic projects with community residents, 2) Capacity to perform outreach required to encourage New Yorkers to get vaccinated, and 3) Ability to receive payment for outreach services.

Organization Details

In order to receive payment, please provide the following information: 

Address

Does your organization have an EIN#?

If your organization does not have an EIN# please provide the name and contact information for an organization to act as your fiscal sponsor.

Address

Organization Criteria  

Organizational History/Strengths:

In 100 words or less, please describe your organization’s history and/or work providing services, running community projects and events or organizing community residents or connecting residents to services, benefits or programs in low-income New York neighborhoods.

Identify the ZIP codes your organization typically serves (Select Boroughs to see available zip codes)

Bronx zip codes

Brooklyn zip codes

Manhattan zip codes

Queens zip codes

Staten Island zip codes

How do you plan to reach community members to encourage vaccination? (choose one or multiple)

NYC Vaccine Referral Bonus Program Information  

How did you hear about this program?

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