Community Health Worker Training – Registration

CHW Training Registration

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  • Are you fluent in other Languages? (Please specify)

  • Please provide a personal statement of why you are interested in becoming a CHW (Initial Certification Only):
  • Media Consent

  • Please download the Media Consent Form, sign and scan (or take a photo) and upload the signed photocopy of the form. (You may also email the consent form to )
  • Accepted file types: jpg, gif, png, pdf, Max. file size: 2 MB.
  • Thank you for your interest. We will contact you shortly.