Skip to main content

For your information:

After you apply, end your session to protect your data.

Community Health Worker Certification Application

Application to become a certified CHW. It is valid for 2 years from the date of issuance.

1 of 5 Contact Information

What is your name?

Please enter your name as it appears on legal documents.

We'll use this as the primary way to contact you with updates on your application.

We will use this as a secondary method to contact you. We will never send text messages.

Some answers on this page need to be fixed

This page of your application either has some errors or some fields were left blank. If you continue to the previous page, none of the information entered on this page will be saved until the errors are corrected.