Community Health Worker 101 Training Registration

September - November 2026

CHW 101 Training Registration

Attendee Information

First Name

Last Name

Organization

Job Title

Phone

How did you hear about this event?

Contact Information

Street Address

Street Address 2

City

State

Zip Code

Peer-Led Study Groups

Supervisor Information

Are you self-employed?

Yes No

Supervisor's Name

If you're self-employed enter your own name and email address.

Supervisor's Email

Peer-Led Study Groups

The study groups are designed to allow you and your peers to assist each other as you go through the training. You may study together, ask each other questions related to the training, and foster a community environment within your training cohort.

By checking "yes," you are consenting to your name and email being shared with other trainees.

Registration Fee

Billing Information is the same as Contact Information

First Name

Last Name

Street Address

City

State

Zip Code

Please note that training registrations are not confirmed until payment is received in full.

Discount Code

Training Cost: $750.00

Discount: $0.00

Processing Fee: $0.00

Total Payment: $0.00

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