NH Community Health Worker Coalition Registration

What is the purpose of a NH CHW Coalition?
To bring together Community Health Workers (CHWs), along with supportive health professionals, stakeholders and community leaders to promote the role and value of CHWs in improving health outcomes.

What is a Community Health Worker?
A CHW is an important member of the healthcare, public health and human service workforce, and a trusted member of the community. This trusting relationship enables him/her to serve as a bridge between community members in need and the services that can help improve their health and quality of life.

Why Join the Coalition?

Be part of a unified CHW movement.
Gain new experiences and leadership skills.
Receive on-going education and discover networking opportunities.
Be part of a healthcare solution.
Help promote unity among diverse populations and discover available resources.

Question Title

* 1. Coalition Member Information

First Name:

Last Name:

Email:

Phone:

Organization:

Job Title:

Address:

City/Town:

State:

Zip:

Question Title

* 2. Are you a Community Health Worker or Stakeholder?

Community Health Worker (or similar role, such as: patient navigator, support specialist, outreach worker, etc.)

Stakeholder (supervises, supports, or works with Community Health Workers)

Question Title

* 3. How did you hear about the NH Community Health Worker Coalition?:

Employer

NH CHW Promotional Materials

NH CHW Website

Event or Training (conference, course, CHW Summit)

Friend or Co-worker

Please specify:

For more information about the NH CHW Coalition, or the Northern or Southern NH AHEC, please contact:

NH CHW Coalition Steering Committee
- NHCHWCoalition@outlook.com
- To learn more about NH CHW Coalition, visit: http://www.nhchw.org
Northern NH AHEC Region:
- Nancy Frank, CEO, North Country Health Consortium, at nfrank@nchcnh.org
- To learn more about Northern NH AHEC, visit: http://www.nchcnh.org/

Southern NH AHEC Region:
- Paula Smith, Director, Southern NH AHEC, at psmith@snhahec.org
- To learn more about Southern NH AHEC, visit: http://www.snhahec.org/

Once the NH CHW Coalition receives your registration, you will be contacted by a Coalition representative. Thank you for your interest in joining this effort.