2019 Hybrid Online Community Health Worker (CHW) Training Registration Form
The NvCHWA Hybrid Online CHW training course is an eight week course which consists of two mandatory in-person classes and six weeks of online course material.

We are proud to offer four courses in both 2018 and 2019, please select your preferred date in the form below.

The in-person days occur on the first and last days of class. Plan on the first in-person day being a full day and last in-person day being just a morning. The class locations will vary based on registrant interest. Please select your location preference in the form below.

Thank you for your continued support of the NvCHWA!

First Name *
Your answer
Last Name *
Your answer
Email address *
**Please ensure your email is correct. Confirmation and course correspondence will be sent to the email provided.
Your answer
Organization (if applicable)
Your answer
Position Title (if applicable)
Your answer
Phone number
(xxx)xxx-xxxx
Your answer
Which location would you prefer to take the training? *
Training locations will be decided on based on interest from registrants and availability of space and facilitators. We will email you approximately 4 weeks before class starts with the final location of the course. Please note: only a Fallon location will be offered for our September 2018 training.
Which Date would you like to register to take the course? *
Registration for the following date(s) are now closed: January 19th, 2018 - March 16th, 2018, April 13th - June 8th, 2018, and July 6th - August 31st, 2018, September 21st - November 13th, 2018.
Are you registering as... *
If you have been given a registration code please put your registration code in the "Other" section
In what county do you currently reside and/or work? *
Are you currently working.... *
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