Spring 2026 Community Health Worker Training Program Registration Form
Please complete this form to register for the Eastern Shore Area Health Education Center's CHW Training.   Attendance at a virtual orientation session is mandatory to participate in CHW Training.

This training is virtual but also requires classwork outside the training sessions as well as a 40 hour practicum experience.
The training will be March 9th, 2026 - April 10th, 2026 (Monday, Tuesday, Wednesday virtual class; 9:00 am - 12:00 pm) with Friday Self-paced sessions

*Note: This is not an interest form, this is for enrollment into the CHW Training.

If you are uncertain and have more questions, please reach out to Lisa Widmaier at lwidmaier@esahec.org. PH: (410) 221-2600 Ext 110

The Maryland Area Health Education Center CHW training curriculum is accredited by the Maryland Department of Health.  The program is designed for anyone wanting and wishing to work in the field of community public health, as well as those already established and looking to enhance skills.  Individuals who complete all training requirements can apply for MD state certification.

Our mission is to train CHWs to help bridge the healthcare gap for our rural and/or underserved communities. These CHWs will be able to identify and facilitate access to resources, navigate the healthcare system and provide health education.
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Full Name *
Personal Email *
Personal Phone Number
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Are you currently employed? If so, list your employer below.
If you are employed, you must provide your employer's contact information including name and email address. (If unemployed, please type N/A). *
Work Email *

Please explain why you would like to become a community health worker.

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What qualities do you possess that would help you excel in this program?

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In what ways are you connected to your community?

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I hereby acknowledge this class requires access to reliable internet and a desktop/laptop computer. *
I hereby acknowledge this class requires time outside the virtual training sessions for homework/assignments. *
I hereby acknowledge that attending one of the two virtual orientation sessions (dates to be determined) is a mandatory requirement for participation in the Community Health Worker (CHW) Training program. I understand that failure to attend either of the orientation sessions will prevent me from joining CHW Training. *
I hereby acknowledge a 40-hour practicum experience is required before being granted my Maryland Area Health Education Center (MAHEC) CHW training certificate.  The practicum is completed outside the virtual training.  ESAHEC is not responsible for placing me at a field practicum site.
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I hereby acknowledge this class does NOT automatically guarantee Maryland CHW Certification.  I will need to complete a separate application process after training completion. *
There is a cost of $1,400 for this training. *If self-paying, a $100 deposit is required BEFORE training begins. How will you be paying for this training? *
If your employer is paying, please list the contact person's name and email for billing questions.
What payment plan are you agreeing to? *
  Participants who withdraw before the training start date will receive a refund of any fees paid except for the deposit (if applicable). The $100 deposit will be forfeited. After the training starts, no refunds will be given.  Payment must be made in full by the end of Week 5.  If payment is not received in full by Week 5, the participant will not receive a certificate of completion.  Payments are non-refundable once training has begun.  By filling out your full name, you agree to this statement.


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Please note that if all course requirements are not completed by their respective due date, you will be required to repeat the CHW Training course AND practicum hours during the Fall 2026 cohort. Any payment received will be transferred over to cover Fall 2026 training. By filling out your full name, you agree to this statement.


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 If you are currently employed, you are REQUIRED to notify your employer of your participation in the training to allow time for the training during work hours (9:00am- 12:00pm). You must be fully present during class. Completing work duties during training or scheduling client and patient appointments during the timeframe of the sessions are not allowed. You must be in a stationary position during class. Please type your name below to document your understanding of this requirement.


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