CHW Screening Form

CHW Student Bio Form

Student Name *

Preferred Nickname

Phone

Instruction for the CHW training program is provided by 20+ Subject Matter Experts (SMEs) in their respective field of expertise. Each session will begin with introductions. To maximize instructional time and tailor instruction to your needs, please provide written responses to each of the following questions:

City

State

Zip

1. How did you come to enroll in this course or program? *

2. In your own words, What is a Community Health Worker? *

3. What are your greatest skills or strengths? *

4. What are your greatest fears? *

5. Do you have experience working as a Community Health Worker (paid or volunteer)? *

6. What do you hope to gain from this class? Keep the information you include, and the tone you use (i.e., language, approach) professional and relevant to participation in the course. *

7. Include professional and personal information.

It's helpful to include something about you and your interests outside of class. Adding your location may also be beneficial – many students like to meet in person if they can, and study groups
emerge this way. Providing your city is fine, no need to include details such as your home address. Offering up your time zone at a minimum does give some indication of your availability for
group work and live sessions.

8. Add a picture of yourself. From the instructor's perspective, it's always nice to put a face with a username.

Maximum file size: 516MB

9. Focus on your instructors and classmates.

Another tip from Inc. that applies to education is to "focus on the other person." As you move through courses in your online program you'll encounter the same group of students and will get
to know each other better along the way, but in that first class everyone is new. What do you want them to know about you? Asking yourself: "What do I want to know about them?" may be
a good place to start. *

10. Upon course completion, what population would you like to serve and why? *

11. Where you live, what is the community’s greatest need? *

If you are human, leave this field blank.