2017 BPS Student and Parent CHW Program APPLICATION

We are currently recruiting 10 Buffalo Public School students (BPS) in grades 9-12 and 10 BPS parents for Community Health Worker (CHW) training and school health promotion activities in the 2017-2018 school year. Parent and student CHW’s will receive a stipend for participating in CHW training and being involved in continued health-related work in the schools.

If you would like to apply to be a parent or student CHW, please fill out this application. All applications MUST be received by AUGUST 14th AT 5PM to be considered. We will notify applicants who are accepted by August 17th.

To be eligible for selection, parent and student CHW’s must be able to attend a training to be conducted on August 21, 22, 23, and 24 from 9am-4pm (YOU MUST ATTEND ALL FOUR DAYS, FOR THE FULL TIME EACH DAY).   Parent and student CHW’s will be ALSO be responsible in the upcoming school year for building relationships with other parents and students to encourage and support health education and promotion, serving on their building-level school wellness team, and being a part of a District level project of their choosing (relating to a topic of interest such as nutrition, physical activity, sexual health, mental/emotional/behavioral health, etc.)

Community Health Worker training will be delivered by the Community Health Worker Network of Buffalo, and will build knowledge, skills, and qualities to support parents and youth to create healthier schools and communities.  Topics will include understanding and addressing issues related to education, health, and income, effective communication, supporting positive behavior change in individuals, families and communities, and more.  This training is an initiative of the School Wellness Collaborative of Buffalo- a partnership of Buffalo Public Schools, D'Youville College, Canisius College, the District Parent Coordinating Council, Buffalo Parent Teacher Organization, the Community Health Worker Network of Buffalo, and many other community partners. 

If you have questions about this application or the program, please contact Jessica Bauer Walker at jessica@chwbuffalo.org or 716-548-6727.

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* 1. Are you a parent or a student in the Buffalo Public Schools?

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* 2. Please tell us how we can contact you.

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* 3. STUDENTS- please indicate the grade you are entering this Fall.  PARENTS- please indicate the grade(s) your child/children are entering. (please check all that apply)

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* 4. What school(s) will you (or your child, if a parent) attend this Fall?

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* 5. School and Community Wellness/Parent or Student Leadership Experience:
Please list any groups or activities you have been part of to help support healthier schools and communities.

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* 6. Please tell us about other Work or Volunteer Experience:

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* 7. Please describe WHY you would like to be a STUDENT or PARENT community health worker:

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* 8. I am able to attend a training to be conducted on August 21, 22, 23 and 24 from 9am-4pm (ALL FOUR DAYS), to take place at Canisius College.

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* 9. If selected for the CHW training program, I will commit to participation through the school year as a parent/student CHW.  (This will be a commitment of about 4 hours/month.  You will receive a stipend for participation).

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* 10. Please list a person associated with your school or community work/volunteer experience that we can contact as a reference.

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