CHW Interested Candidates

Please complete this form and submit it. All information shared on this form is private and is only view by the Heritage Care director of education.

 
 
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When are you available Monday through Friday for class?

 

Please list the area of community health work that most interests you from the list

 
 
 
 
 
 
 
 
 

Can you provide a lease or utility bill that proves you live in the address listed?

 

Can you provide 6 months of paystubs to prove your income or a letter of support if you were unemployed?

 
 

Can you provide 6 months of paystubs to prove your spouse's income or a letter of support if he/she was unemployed?

 

How many people, including yourself, live in your house/apartment?

 

Will you need a transportation stipend to help cover the cost of getting to and from class?

 

Will you need childcare during your class hours?