San Antonio Community Health Workers Association Membership Form
2021 Updated membership form. The answers to these questions help us describe who we are as an Association.
Please enter your name (First and last name):
Preferred email address (Personal or professional email)
Preferred method of contact:
Please select the option that applies to you, I am a ...
DSHS Texas certified CHW/Promotor
DSHS Certified CHW Instructor
If you are a certified CHW, How did you attain your CHW certification? please enter the name of the certification program you completed OR specify if you attained your certification based on experience.
Department of State Health Services (DSHS) Search for a license/certificate Tool
If you are DSHS Texas certified, please enter your CHW and/or CHWI certificate number
Which category below includes your age?
70 or older
Which of the following describes you?
Black or African-American
American Indian or Alaskan Native
Native Hawaiian or other Pacific islander
Gender: How do you identify?
Non-binary (A person whose gender identity does not fall within the binary genders of man or woman)
Prefer to self-describe, below
Using personal pronouns is a form to show respect and a way to create an inclusive environment for all. To learn more about this follow this link:
What pronouns do you prefer/use?
Prefer not to answer
What is the highest degree or level of school you have completed?
Some high school, no diploma
High school graduate, diploma or the equivalent
Some college credit, no degree
Trade/technical/vocational training (CHW Level 1 certificate)
Employment Status: Are you currently…?
Employed full time
Employed part time
Out of work and looking for work
Out of work but not currently looking for work
Seeking volunteering opportunities only
Unable to work
What language (s) are you fluent in...?
English and Spanish
Other, please specifiy below
If employed, please enter your employer agency
Enter your job title (for example CHW, patient navigator, health educator e.t.c)
Enter your area of expertise (outreach, diabetes education, parenting classes, cancer patient navigation e.t.c
Enter the city, sate and zip code of the geographical area you serve through your work, volunteering and school internship activities
If you live in San Antonio/Bexar County, TX. Please enter your household's zip code.
I am interested in joining San Antonio Community Health Workers Association (SACHWA). Mark all that apply to you:
General Membership – Be notified and attend Events and Continuing Education programs.
Help promote event meetings/invites, and moderate open group forum.
Advocating for Community Priorities - Connecting priorities of community residents, employers and other working groups/coalitions that align with the field of Community Health to general group.
Assist in all advocacy projects to promote our profession.
Assist in updating and maintain the SACHWA’s website.
Actively develop CHW networks with agencies and organizations.
Interested in presenting to the group (work related projects, well researched topics of interest toward professional or skill set development)
What do you expect from being a member of the SACHWA?
If you have any comments or ideas, please enter them below.
Association Monthly Meeting:
Currently, we host remote monthly meetings every fourth Thursday of the month from 2:00 pm to 4:00 pm. If interested in presenting, please email us at:
to add you to our monthly calendar.
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