Community Health Worker Certificate Program

Your Information

Enter your FIRST and LAST name.*

What is your email address?*

Telephone Number*

Please include your area code, too.

What city do you live in?*

Language Fluency*

What languages other than English do you speak? How about reading/writing? Please vividly describe other languages and fluency.

If you do not speak another language besides English, write N/A.

Foothill Experience

Have you ever taken classes at Foothill?*

Yes

What is your Student ID Number?

This is also known as a CWID (Campuswide ID)

Course Information

Course completed*

Select any of the following courses that you have completed within the past 2 years with a C grade or better OR are currently taking.

Otherwise, select "I have not completed any of these classes".

HLTH 21: Contemporary Health Concerns

CNSL 6: Exploring Leadership

HLTH 101: Intro to Community Health Work

I have NOT completed any of these classe

Which classes have you taken?

Which classes (HLTH 21, CNSL 6, and/or HLTH 101) have you completed? Which ones are you currently taking?

Schedule for Fall and Winter*

Students in the CHW program will have the following schedule (minus any classes previously completed):

Fall 2025 - Sept - Dec:

HLTH 21: Contemporary Health Concerns (online class)

HLTH 101: Intro to CHW (in-person on Saturdays from 10a-1250p)

Winter 2025 - Jan - Mar:

CNSL 6: Exploring Leadership (online class)

ITRN 51: 72 hour Internship (in-person)

Select

Previous Experience as a CHW

Many students are new to the field while some students are experienced CHWs. Please answer the questions below so we can assist you.

Have you worked as a CHW before?*

CHW experience covers a wide range of positions and not always called a community health worker. For example, you may have experience with health education, peer counseling, resource navigation, motivational interviewing, etc.

Many experiences qualify as long as you have at least 300 hours in the past 2 years either paid or volunteer work.

Select or enter value

What organizations have you worked with?*

What are the name of the organizations you've worked with as a CHW? List all organization names. Describe some of the job tasks you had.

Do you have any questions for us?

Please let us know if you have any questions about our program. Ensure that you check your email often as we will send announcements throughout the year.

How did you hear about us?*

Please let us know how you heard about our CHW program.

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