Vaccination Incentive Program
August 30, 2021
On August 17, 2021, Fayetteville City Council unanimously passed a resolution establishing an incentive program offering a one-time payment of $100 to individuals living or working in Fayetteville who become fully vaccinated against COVID-19 beginning August 17 through October 15. This also applies to students living in Fayetteville while they attend the University of Arkansas. An initial $400,000 from the City’s American Rescue Plan funding was approved to fund this program. The deadline to apply for incentive payments is November 1, 2021.
To qualify, you must have received your second dose of the Pfizer or Moderna vaccine, or single dose of the Johnson & Johnson vaccine within the eligibility time period.
Please note: incentive payments are limited to one per individual. The incentive does not apply to "booster" shots.
Please use this form to apply for your incentive payment. You will need the following documentation:
- A photo of your vaccination card showing your name and date of birth, along with the date(s) of your vaccination(s), vaccine brand (Pfizer, Moderna or Johnson & Johnson), and the vaccine lot number.
- If you are a resident of Fayetteville, you will need proof of current residency: A photo of your ID with your address, a recent utility bill, or lease agreement.
- If you work in Fayetteville, but live elsewhere, you will need to provide proof of current employment in Fayetteville, such as a photo of a paystub, 1099 form, or invoice for work performed during the eligibility time period.
Applying for Vaccine Incentives for Children
If you are a parent or guardian of children who have completed their full vaccination between August 17 and October 15, 2021, there is a place on this form where you may include their vaccination information as well. You do not need to complete separate forms for each child.
Community Resources Assistance
For Fayetteville residents without a permanent address, the City's Community Resources Department will be available at the following locations to assist eligible persons to apply for incentive payments:
Time for all dates/ locations is 2 to 3 p.m. Click here to download a flyer with these dates.
- Tuesday, Sept. 21: Salvation Army, 219 W. 15th St.
- Tuesday, Sept 28: 7hills Homeless Center, 1832 S. School Ave.
- Tuesday, Oct. 5: Genesis Church, 205 MLK Jr. Blvd.
- Tuesday, Oct. 12: Salvation Army, 219 W. 15th St.
- Tuesday, Oct. 19: 7hills Homeless Center, 1832 S. School Ave.
- Tuesday, Oct. 26: Genesis Church, 205 MLK Jr. Blvd.
After you have submitted this form, City staff will review the information you provided and will contact you regarding the status of your application within two business days.
Claiming your Incentive Payment
If your application is approved, the payment will be given in cash. To pick up your payment, you must come in person to Fayetteville City Hall, 113 West Mountain St. A photo ID will be required.
If you have questions, or want to check on the status of an application, call during regular business hours: 8 a.m. to 5 p.m.
Fayetteville City Hall
113 W. Mountain St.
Hours: 8 a.m. to 5 p.m.