Community Health Worker - Supervisory Training Program Application

Thank you for your interest in the LPCA's Community Health Worker Supervisory Training Program.

We are currently accepting applications for our 1st cohort for the Supervisory Program. Please complete all required fields on this form and we will be in touch as soon as possible.

For any immediate questions, please contact Erica Rose-Crawford, Statewide Program Manager, at ecrawford@lpca.net.

First and Last Name*

Email Address*

What race to you best identify as:*

African American

White

Asian

American Indian

Alaska Native

Native Hawaiian

Pacific Islander

What ethnicity do you best identify as:*

Hispanic/Latino

Non- Hispanic/Latino

What gender do you best idenfiy as:*

Male

Female

Trans-Male

Trans-Female

Nonbinary

Agender

Gender- Expansive

Gender- Transition

Prefers not to answer

What parish do you live in?*

Select

Are you currently employed?*

Yes

If you are current Employed, please specify the title of your current job.*

Have you ever worked in a Federally Qualified Health Center (FQHC) or heatlhcare-related field?*

Yes

Have you had Community Health Worker Training before?*

Yes

If Yes, please specify the type of training (i.e., school name, training program name)*

How many years have you had experience as a Community Health Worker?*

No CHW experience

Less than one year

2+ years as a CHW

Have you had or participated in Leadership Training before?*

Yes

If yes, please specify the type of training.*

Send me a copy of my responses

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