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WI CHW Network Co-Chair Application

WI CHW Network Co-Chair Information


This form is used as an application to apply to serve a 2-year term as a c-chair on the WI CHW Network Committees . Please note the following requirements:
*Must be available to attend and co-facilitate meeting on a quarterly basis in the afternoon.
*Meetings will be facilitated remotely via Zoom.
*The Committees encourage representation from diverse members of the WI CHW Network regions.
*Each committee must have at least one CHW as co-chair.
*If you are not a CHW, you can still apply and serve as an ally
*Must contribute to association activities and be present at special events (ex: annual conference) and other projects when needed.

1.What is your first name?(Required.)
2.What is your last name?(Required.)
3.What is your email address?(Required.)
4.What is your phone number?(Required.)
5.What is your address?
6.What is your Organization/Agency name?
7.Did you complete the Community Health Worker training?
8.Why are you interested in serving as a co-chair of the WI CHW Network?*
9.Describe your skills and leadership experience
10.Describe ideas you have that will help grow the WI CHW Network
11.Describe your availability to attend and co- facilitate Committee meetings?
12.Please copy and paste your resume here (don't worry about the layout):
Current Progress,
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