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Community Health Worker Trainee Interest Form
Please fill out this form if you are interested in CHW training. Someone from our team will be in touch with you within one week of submitting this form.
Slots are limited. Placement is not guaranteed
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Name
*
Your answer
Email
*
Your answer
Phone
*
Your answer
Best time to contact
*
Morning
Lunch Hour
Afternoon
Evening
Required
HRSA CHW Trainees are required to be 18 years old, have a GED or high school diploma, be US Citizen or permanent resident and live in Colorado. Do you meet these requirements? (If not, we can talk about other opportunities for training)
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Yes
No
City and zip code of where you live:
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Your answer
I am most interested in:
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Training with Internship (100 hours of training followed by 120-hour internship)
Training with Apprenticeship (1-year commitment)
Unsure, need more information
Date available to start training
Your answer
How did you hear about this opportunity?
*
PNCT Website
PNCT Newsletter
Alliance Newsletter
Colorado AHEC
Other:
Questions for us?
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