Community Health Worker interest form
Commonpoint Queens, in partnership with LaGuardia Community College, bring you a 16-week Community Health Worker (CHW) training and job placement program. Anyone wishing to work full-time with the community, connect citizens with pertinent health information, and provide resources to families and individuals should consider getting certified as a Community Health Worker. 

This specific program is offered for those whose native language is one other than English. Additionally, proper work authorization / social security card documentation is required. 

Please complete the form below. 
Sign in to Google to save your progress. Learn more
What is your first and last name?
What is your email address?
What is your phone number?
What is your primary language?
Do you have a social security card or work authorization?
Clear selection
Are you vaccinated against Covid-19?
Clear selection
Are you a current client of Commonpoint Queens?
Clear selection
Do you live in one of the five boroughs (Manhattan, The Bronx, Queens, Brooklyn, or Staten Island)?
Clear selection
Do you have a high school diploma (from the U.S. or from another country)?
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Commonpoint NY, Inc..

Does this form look suspicious? Report