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Community Health Worker Certification Program

APPLICATION

- Provide an Photo copy of your identification and your resume with your application.
- Program details at https://www.healthcareaccessnow.org/certification-and-education/certification-program/
- Admittance to the program requires an online career assessment and a copy of your driver's license and high school diploma or GED BEFORE being accepted into the program. Look for directions to take the career assessment after you submit this application.
1.Select one session.

Days/Time:
Morning Classes-Mondays and Fridays: 9:00 a.m. to 1:30 p.m.
Morning classes- Tuesdays and Thursdays: 9:00p.m. to 1:30p.m.

(Evening classes are on a demand basis)(Required.)
2.ADDITIONAL CERTIFICATION OPPORTUNITY: Optional certificates are available. Please indicate whether you plan to participate in an additional training. Fees apply. Download the MHFA Training brochure for more information.(Required.)
3.A 130-hour community-based practicum is required by the Ohio Board of Nursing for certification. Will you be completing your practicum where you work or will you need a placement?(Required.)
4.How did you hear about the HCAN CHW Certification Training Program?(Required.)
5.Name(Required.)
6.Contact Information(Required.)
7.Personal Data(Required.)
8.Race/Ethnicity(Required.)
9.Are you Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, Cuban-American, or some other Spanish, Hispanic or Latinx Group?(Required.)
10.Military Service - have you ever served or are you now serving in the military?(Required.)
11.Emergency Contact(Required.)
12.Academic Information(Required.)
13.Employment History - Current or Most Recent(Required.)
14.Employment History - Job 2(Required.)
15.Personal Statement
Why are you interested in going through this program and what are your expectations?
300 words or less(Required.)
16.THREE Professional/Personal References (cannot be family members)(Required.)
17.What is your planned method of payment? HCAN accepts Visa, MasterCard and Discover, cashier checks, employer checks, and cash payment . No personal checks, scholarships are on an as NEEDED bases.(Required.)
18.INVOICE - If your employer or a company is paying the tuition, provide contact information for the person that should receive the invoice.(Required.)
19.Let us know here if there is anything else you wish to share.(Required.)
20.Upload Photo copy of any form of Identification(Required.)
No file chosen
21.Upload copy of your resume and/or recomendation letter.(Required.)
No file chosen
Your application is complete upon receipt of the application fee. Check your email for the payment link, emailed in 1-2 business days, or go to the healthcareaccessnow.org webpage to pay now with a credit card online or with a cashier's or employer's check (personal checks not accepted).

When you click 'APPLY' your application will be submitted. Thank you!!