Application chw form 2026

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  1. Click ‘Get Form’ to open the application CHW form in the editor.
  2. Begin by entering your personal information. Fill in your last name, first name, and student ID number. Ensure that you provide a valid mailing address, including city, state, and zip code.
  3. Next, complete the education section. Input the dates attended for high school and college/university along with the diploma or degree awarded.
  4. In the employment history section, list your last four employers. Include their names, cities, states, positions held, employment dates, reasons for leaving, and relationships to references.
  5. Finally, read the certification statement carefully. Type your first and last name as a signature and include the date of signing.
  6. Once completed, download the application to your computer. Type responses directly into the form before printing it out for signing.
  7. Email the completed application along with a letter of intent to taira.kochar@centralaz.edu as instructed.

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Certification provides the potential for pay increases and stable employment.
Almost all CHW certification programs require applicants to renew their certification on a two- or three-year cycle. CHWs may have to pay a recertification fee (typically $25-$100) and demonstrate completion of a certain number of continuing education credits (on average 10-15 hours of continuing education per year).
CHW perks. If you are contracted and credentialed with the Alliance, you can receive reimbursement at up to 150% of Medi-Cal rates for services. Eligible health care organizations can apply for an Alliance grant and be awarded up to $65,000 in Medi-Cal Capacity Grant Program funding to recruit and hire CHWs.
Texas CHW Certification Requirements Training Completion of an approved DSHS certified 160-hour competency-based Community Health Worker training program. OR Experience At least 1000 cumulative hours of community health work services within the most recent three (3) years.
Community Health Workers Salary in California Annual SalaryMonthly Pay Top Earners $57,240 $4,770 75th Percentile $49,300 $4,108 Average $44,336 $3,694 25th Percentile $37,500 $3,125

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