Host Sites Interest Form: Future Colorado Healthcare Corps Programming

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While the 2021-2022 Colorado Healthcare Corps program is now closed and we are no longer accepting new host sites, we have put together an interest form for any future partnership opportunities.

Please fill out this form below to express your interest in partnering as a host site for future CHC programming and we will be in contact with you as new opportunities arise and check out our website at https://crcamerica.org/ for all CRC partnership opportunities!

First and Last Name *

Name of Organization: *

Email Address: *

Phone Number: *

Address of Organization: *

What positions are you interested in having future Colorado Healthcare Corps members serve in at your organization? *

Uncertified Patient Care Assistant/Direct Support Specialist

Certified Nursing Assistant

Patient Transport Specialist

Patient Safety Assistant

Behavioral Tech

Pharmacy Tech

Medical Assistant

Qualified Medication Administration Personnel (QMAP)

Patient Navigator

Other:

Required

What types of partnership opportunities are you interested in? Please check all that apply: *

I am only interested in partnering with CRC for Colorado Healthcare Corps (CHC)

I am interested in partnering with CRC for AmeriCorps VISTA opportunties

I am interested in partnering with CRC for any National Service opportunity (does not have to be healthcare focused)

Required

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