Community Health Worker Training Program Application

Community Health Worker Training Program Application

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

We are currently accepting applications for our next cohort for Certified Community Health Workers / Navigators. 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.

How did you hear about this program?*

Select

First and Last Name*

Email*

What best defines your Race:*

African American

White

Asian

American Indian

Alaska Native

Native Hawaiian

Pacific Islander

What best defines your Ethnicity:*

Hispanic/Latino

Non- Hispanic/Latino

What Parish do you live in?*

Select

What is your Citizenship Status?*

Yes

Visa

Student Visa

Do you have any experience as a CHW?*

CHW - Community Health Worker

No CHW experience

Less than one year

2+ years as a CHW

If you selected "Other" Relevant Experience, please specify here:

Please select which of these benefit(s) you receive:*

Please select all that apply.

(Disabled )Retired Military Veteran

SNAP/EBT/TANF

LaCHIP

Disability benefits

Medicaid

Medicare

Child Care Assistance

Subsidized Housing Program (Section 8)

None of the Above

Please upload your resume and any additional documentation here.*

Drag and drop files here or

Send me a copy of my responses

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