Health & Racial Equity Training Registration

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Health & Racial Equity Training Registration

Join us for this engaging and impactful training!

This training 20-hours. Typically facilitated in a 5 day format for virtual training and a 2 day format for in-person training. Our Health & Racial Equity training is made possible by Johnson & Johnson's Our Race to Health Equity Campaign.

There are only 20 available slots for this training. Slots will be filled on a first come first serve basis - based on the time of registration. Any additional registrants will be utilized as a waitlist. In the event someone is unable to attend you will be contacted. To be eligible you must be able to attend the training in its entirety.

If you have any questions or concerns, please contact CCHA Training at CHWInstitute@gmail.com

Trainee's First Name: *

Trainee's Last Name: *

Email address you would like training correspondences and confirmation sent to: *

Trainee Phone Number: *

Organization employed by: (If independent, put N/A) *

Address of place of employment: (If independent, put N/A) *

Title within organization: (If independent, put N/A) *

Training dates you would like to attend: (please select all that apply) *

I would like to be notified of the next VIRTUAL training sessions.

I would like to notified of the next IN PERSON training sessions.

Required

Please select the statement that describes your work in health & racial equity best: *

I am not a CHW, but I am interested in learning more about health & racial equity.

I am a CHW interested in learning more about health & racial equity.

I have under 2 years experience in community health work with a focus on health & racial health disparities.

I have over 2 years experience in community health work with a focus on health & racial health disparities.

What race/ethnicity do you identify with?
*

American Indian/Native American/Pacific Islander

Asian

Black/African Ancestry

Hispanic/Latinx Black

Hispanic/Latinx White

Non-Hispanic White/Caucasian

More than one race

Another race

Prefer not to share

Required

How do you describe the populations or communities that you work directly with? (for example, rural elderly, perinatal Latinx families, uninsured patients, CHWs in South Carolina, state policymakers…)
*

Approximately how many families, clients, participants, and/or patients do you work with on an annual basis?
*

I understand that by signing up for this training I am agreeing to attend each of the sessions for their full duration and give feedback by way of survey:
*

Yes

No, but I would like to follow up with CCHA because I am interested in future experiences offered

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