DOH-UH Statewide COVID-19 Contact Tracing Training Program

UPDATED Participant Interest Survey

Please email the UH System Office of Strategic Health Initiatives at oshi@hawaii.edu for more information.

Question Title

* 1. Contact Information

First Name *

Last Name *

Address *

City/Town

County *

State/Province *

ZIP/Postal Code *

Island *

Email Address *

Phone Number (e.g., XXX-XXX-XXXX) *

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* 2. Which track are you most interested in (and best suits your background/experience)?

Community Contact Tracer Training (6 weeks [online]; Minimum requirement: Completion of bachelor's degree [health career oriented preferred])

Community Health Worker (CHW) Training (16 UH credit certificate program open to all with high school diploma or GED)

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* 3. What is your highest level of education?

High school diploma/GED

Associate's

Bachelor's

Master's

Doctorate

Current undergraduate

Current high school student

None of the above

Please list the higher educational institutions that you have attended, and for which degree/s.

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* 4. Did you graduate in 2020 (i.e., new graduate)?

Yes

If "yes," please input your degree, major, and institution.

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* 5. Do you have at least an undergraduate degree and clinical health background?

Yes, I am a Registered Nurse

Yes, I am a Nurse Practitioner

Yes, I am a Licensed Clinical Social Worker

Yes, I am a Pharmacist

Yes, I am a Physician

Yes, I am a Physician Assistant

Yes, I am an Emergency Medical Technician (EMT)

Yes, I am a Paramedic

Other clinical profession, Other clinical experience, or Other details

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* 6. Are you currently working?

Yes, full-time

Yes, part-time

Retired

Other (please specify)

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* 7. Do you speak another language?

Yes (please specify)

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* 8. Applicants should be available to be activated by DOH on an as-needed basis for a short-term period (full-time hours) upon program completion. A smaller number of part-time applicants (20hrs/week) will be considered. If you are not able to work at least 20 hours per week, unfortunately you are not eligible to participate at this time. What is your availability?

Able to work full-time (40hrs/week) for a short-term period (i.e. up to three months)
(Note: Those available full-time have the highest priority for training)

Only able to work part-time (20-39 hrs/week) for a short-term period (i.e. up to three months)
(Note: Those available part-time have lower priority for training)

Question Title

* 9. Are you willing to join the Hawaii State Department of Health’s Medical Reserve Corps (link to website here)?

Yes

Maybe/Unsure

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* 10. Please include any other information you wish to share. (For example, please feel free to share your years of relevant work experience(s) and other important considerations.) If you wish to submit your resume/CV, please email us at oshi@hawaii.edu.