Community Health Worker Training: Insurance & Finances 101

Please complete the information below to register for this free training for Community Health Workers offered by Triage Health.

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1. First Name (Required.)

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2. Last Name (Required.)

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3. Email Address (Required.)

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4. Phone (Required.)

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5. Street Address (Required.)

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6. City (Required.)

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7. State (Required.)

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8. Zip Code (Required.)

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9. Company/Organization (if applicable)

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10. Title (if applicable)

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11. How did you hear of this training? (Required.)

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12. Are you a (please check all that apply) (Required.)

Volunteer Community Health Worker

Paid Community Health Worker

Certified or Professionally Trained Community Health Worker

Other (please specify)

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13. What age range applies to you?

0-18

19-39

40-64

65+

Prefer not to share

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14. I identify my race/ethnicity as

Native American

Asian or Pacific Islander

Black or African American

Hispanic or Latinx

Middle Eastern or North African

White

Prefer not to answer

Other (please specify)

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15. What gender do you most identify with?

Woman

Man

Transgender

Non-binary/non-conforming

A gender not listed here

Prefer not to answer

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16. What is your current education level?

Some high school, no diploma

High school graduate, diploma or the equivalent (for example: GED)

Trade/technical/vocational training

Associate degree

Bachelor’s degree

Master’s degree

Professional degree

Doctorate degree

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17. If you need an accommodation, please describe:

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18. Why are you in need of this training? (Check all that apply) (Required.)

Community members ask me these questions

To better help my community members navigate these issues

To increase my understanding of these topics

To advocate for policy and legislative changes related to these topics

Free continuing education

Other (please specify)

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19. How do you plan to use the information from the event? (Check all that apply) (Required.)

To better help my community members navigate these issues

To advocate for policy and legislative changes related to these topics

To help a family member or friend navigate these issues

To help myself navigate these issues

Other (please specify)

Community Health Worker Training: Insurance & Finances 101

Question Title

* 1. First Name (Required.)

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* 2. Last Name (Required.)

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* 3. Email Address (Required.)

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* 4. Phone (Required.)

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* 5. Street Address (Required.)

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* 6. City (Required.)

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* 7. State (Required.)

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* 8. Zip Code (Required.)

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* 9. Company/Organization (if applicable)

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* 10. Title (if applicable)

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* 11. How did you hear of this training? (Required.)

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* 12. Are you a (please check all that apply) (Required.)

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* 13. What age range applies to you?

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* 14. I identify my race/ethnicity as

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* 15. What gender do you most identify with?

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* 16. What is your current education level?

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* 17. If you need an accommodation, please describe:

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* 18. Why are you in need of this training? (Check all that apply) (Required.)

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* 19. How do you plan to use the information from the event? (Check all that apply) (Required.)

1. First Name (Required.)

2. Last Name (Required.)

3. Email Address (Required.)

4. Phone (Required.)

5. Street Address (Required.)

6. City (Required.)

7. State (Required.)

8. Zip Code (Required.)

9. Company/Organization (if applicable)

10. Title (if applicable)

11. How did you hear of this training? (Required.)

12. Are you a (please check all that apply) (Required.)

13. What age range applies to you?

14. I identify my race/ethnicity as

15. What gender do you most identify with?

16. What is your current education level?

17. If you need an accommodation, please describe:

18. Why are you in need of this training? (Check all that apply) (Required.)

19. How do you plan to use the information from the event? (Check all that apply) (Required.)