Community Health Worker Program Application

Application period for Spring 2020 Enrollment:  Sept. 6th through November 1st.

For this application period, the prerequisite requirement of AH 101 will be waived.

Required fields are marked with an asterisk (*).

Personal Information

  • The following information is very important. Please make sure your spelling is accurate and capitalize as appropriate.

    The demographic questions below do NOT influence your eligibility for the program. They are for program planning purposes. The only factors that influence your eligibility are those in the "Program Prerequisites" below.
  • Contact Information

  • Educational & Military

  • Demographics

 

CHW Program Eligibility

  • REQUIRED FOR APPLICATION: All applicants must have completed, or have in progress during the Fall 2019 semester, the course AH 101: Introduction to Community Health Work.

    For the Spring 2020 application period, the prerequisite requirement of AH 101 will be waived.

    IN-PROGRESS COURSES: Applicants may have this course in-progress during the Fall 2019 semester, proof of enrollment must be submitted. A copy of your fall schedule showing your name, the course(s), and the status of "enrolled" is sufficient.

    COMPLETED COURSE: If you have completed AH101 please upload a copy of your transcript below.

    SUBMIT ONLY REQUESTED DOCUMENTS: Do not add additional documents other than the In-Progress Proof of Enrollment, if applicable.

    FILE TYPE AND SIZE: All documents must be in PDF format and no larger than 3MB. Any file larger than that will not pass the online filters and your application will not be received.

    CHECK YOUR DOCUMENTS: Review your PDF files before submitting them to ensure that no critical information has been cut-off and that all information is included. Partial, cut-off, and blank pages without all required information will result in your application being denied because it is incomplete.

  • Program Required Course: AH101

  • Have you completed AH101? If so please enter your course information here. You will need to upload your transcript(s) to confirm course completion.

    For the Spring 2020 application period, the prerequisite requirement of AH 101 will be waived.
 

Proof of Enrollment or Transcript

 

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