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Welcome, Community Partners and CHWs!  Please complete this RIDOH CHW Program  Contact and Information Form to get started.

***SUPERVISORS AND MANAGERS: PLEASE ENSURE THAT ALL INDIVIDUALS WORKING UNDER THIS GRANT IN YOUR ORGANIZATION COMPLETE THIS FORM TO RECEIVE ALL TIMELY INFORMATION AND ANNOUNCEMENTS RELATED TO THIS GRANT, MEETING INVITATIONS, ETC.

General Instructions
The Rhode Island Department of Health (RIDOH and its new Community Heath Worker (CHW) Program need some basic information about you and your organization. We are working together to TRAIN, DEPLOY, and ENGAGE CHWs to build healthy and resilient communities under the federal Community Health Workers for COVID Response and Resilient Communities (CDC-RFA-DP21-2109) grant award to Rhode Island .

This form will collect your contact information and other important details about your work with us. This helps us to better communicate, respond, and support your organization in an efficient and timely manner.

This form should take just a few minutes to complete. Please respond to each question as best as you can. If you have any questions, please use the Comments Box at the end. You may also email the RIDOH CHW Program Administrator James Day at james.day@health.ri.gov.

More guidance and support for grantees can be found on the RIDOH website at: 

Thanks for your information. We look forward to working with you!

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Let's get started! Please enter your business or work email below!

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Email *
What's your name? Type this in as First name Last name. *
What's your position or title? *
From your organization, who's the lead project officer or point of contact for this project? *
What's the best phone number to call you for grant business? 

Please enter your phone number below and include any extension too.

If you only use a personal phone and don't want to share that, you may leave this response blank and we'll contact you only by email.

Notes: 

- RIDOH office extensions begin with 401-222-XXXX. That's how you'll know we aren't telemarketers or a "scam likely" call. :)

- Our regular office hours are Monday through Friday, 8:30 a.m. to 4:30 p.m.(except for State holidays). If we need to connect by phone, we'll be reaching out during these business hours. 
Enter your work or business phone number here.
What's the name of your Organization or Agency?  

If you work with more than one agency or employer, please select only the organization that you're representing for this CHW grant work.  

Please use the Comments Box at the end if you need to: 
(1) Add an employer that's NOT already listed; or
(2) Give more detailed information about a specific branch, division, or location -- if you think that's important information for us to also have!
 *
Select your Grant Component(s).

RIDOH CHW Program grant contracts have been awarded to community partners under two different categories known as Component-B and Component-C.  Each component has certain goals, deliverables, scopes of work, and reporting requirements.

Please tell us which grant component(s) that your agency or organization is conducting. 

Need more background info or a quick refresher first? Visit:
 *
Required
Which description below best describes your work sector? *
For CHWs only:

Please select all achievements and credentials that apply to you from the list below. 

If you'd like to share anything else about your skills and expertise, please use the Comments Box at the end of this form.

If you are not a CHW, please select "Not applicable".
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Required
CHW Strategy Team Participation: 

Partner organizations funded through the CHW grant are encouraged to attend CHW Strategy Team monthly meetings. Individual CHWs, employers, and other partners are strongly encouraged and welcomed as well!

Virtual (online) meetings are held on the first Wednesday of the month from 3:30 p.m. to 4:30 p.m. No meetings are scheduled in July and December to accommodate summer and winter holiday breaks.

At most or all meetings, Strategy Team members will move into one of the four workgroup breakout rooms to address:

1. Workforce development
2. Advocacy
3. Sustainability
4. Interagency collaboration

For more information, please visit: 


From your organization, who will attend CHW Strategy Team monthly meetings?  

Please select all that apply:
 *
Required
Office Hours Representation: 
From your organization, who will attend the RIDOH CHW Program's Office Hours?

Please select all that apply:
 *
Required
Evaluation Meeting Representation: 
From your organization, who will attend the RIDOH CHW Program's Evaluation meetings?

Please select all that apply:
 *
Required
Please sign up to receive CHW updates directly! 

1.  RIDOH CHW Partner Highlights Newsletter

The RIDOH CHW Program sends out a monthly newsletter to streamline the latest CHW CCR Grant news, resources, CHW success stories, trainings, COVID updates, and other announcements to help support all Rhode Island grant-funded partners and CHW Strategy team members!  Click here for the sign up form.

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2. RIDOH Community Newsletter (formerly known as RIDOH COVID Partner Updates)

Get monthly COVID-19 updates, RIDOH news, announcements, and free resources to protect and support frontline healthcare workers, the general public, healthcare providers, businesses, and others. Topics may include funding, resource, and training opportunities for communities, emergency preparedness and response, disease outbreaks, infection control, flu, vaccination, substance use prevention, teen suicide prevention, healthcare access, chronic disease prevention, health equity, and more!

Information is emailed in English, Spanish, and Portuguese.  Sign up right here! 

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3. CHWARI E-news

The Community Health Worker Association of Rhode Island (CHWARI) sends out e-news twice each week. Get the latest CHWARI training and event calendar listings throughout Rhode Island, networking opportunities, resources, job postings, and more!

Sign up here: 

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4. Envision Equity

Envision Equity serves as the national Community Health Worker (CHW) Training and Technical Assistance Center in support of the CDC CCR grant. Resources are evidence-based and created by CHWs. Everyone is welcome to attend these free trainings!

To receive Envision emails directly, follow instructions at:

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Please confirm the following:
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Required
Comments:

Is there anything else you'd like us to know? Please share here.
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Please hit the '"SUBMIT" BUTTON at the bottom of this page!

A friendly tip before you go: Please visit and bookmark health.ri.gov/chws to get quick access to free resources and information to support CHWs, grant-funded partners, organizations, employers,  healthcare providers, and more!

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 *Disclaimer: Funding for supporting content on this form was made possible by the Centers for Disease Control and Prevention (CDC) grant, Community Health Workers for COVID Response and Resilient Communities (CDC-RFA-DP21-2109). The views expressed in written materials or publications do not necessarily reflect the official policies of the Department of Health and Human Services, nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. 

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