Community Health Worker Apprenticeship Program - Fall 2022
Thank you for your interest in the HRSA-funded CHW Apprenticeship Program, which is a partnership between Holyoke Community College (HCC) and Behavioral Health Network (BHN). HCC has a federal grant from the Health and Human Resources Administration's (HRSA) Opioid Impacted Families Support Program to train individuals in 2 core Community Health Worker classes at HCC. Upon completion of the classes, students can apply for the paid Registered Apprenticeship position at BHN in one of their family-serving programs. This offers a clear entry into CHW employment. To learn more, go to: www.hcc.edu/CHW-Apprenticeship.

**************IMPORTANT. PLEASE READ BEFORE FILLING OUT THIS FORM************************

If you are interested in the Fall 2022 semester start date (September 2022), please complete this form. You will get more information about other enrollment steps required.).

This form is NOT AN APPLICATION, rather a way to get on our program's radar. Once you complete the form, you will be sent next steps you need to take to apply and meet admissions requirements.

Under this funding you are making an 2 semester commitment to classes at HCC, and will also have the opportunity for a 1 year commitment to the Registered Apprenticeship at BHN.  This is a 2 year program that may extend into long-term employment.

If you are accepted into this grant funded program, course tuition paid for by the student funds of the grant. You will also receive a $5,000 stipend during the 2 classes at HCC and a $7,500 stipend during the Registered Apprenticeship.

In order to be eligible for the program, you must be: 1) a US Citizen or US Permanent Resident, 2) eligible for College Level English, or Eng 101, at HCC, 3) be 18 years or older, and 4) successfully meet health clearance requirements. NOTE THAT AS OF JANUARY 2022, STUDENTS MUST BE FULLY VACCINATED FOR COVID-19 TO PARTICIPATE IN ANY ON CAMPUS COURSES. The practicum has additional health clearance requirements.

Please contact Tina Tartaglia, Program Coordinator, ttartaglia@hcc.edu



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Email *
1. Student Name: *
2. Pronouns
3. Secondary Email Address:
4. Student Phone Number: *
5. Student Address (Include STREET, CITY, and STATE) :
Please make sure you put your FULL address in the answer above. INCLUDING City or Town and also State
6. Date of Birth *
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7. Please tell us how you learned about/heard of this opportunity: *
8. Do you speak another language besides English? If so, what language?
9. Current Employer/Organization (for questions 9 - 13, if you are not employed, then enter "unemployed" as an answer) *
10. Current Job Title and a short Description of Duties *
11. Current Employer Address (Street, City, State, Zip)
12. Supervisor *
13. Supervisor's email or phone number *
Program Sequence of Events:
The grant-funded CHW Apprenticeship program consists of:

LEVEL ONE:
1. Class #1: HTH 124-Core Competencies & Health Topics for Community Health Workers (1 semester, 6 credits, 2 Evenings per week)
2. Class #2: HTH 209-Practicum for Community Health Care Workers (1 semester, 3 credits, 1 Evening per week)

LEVEL TWO:
1. Registered Apprenticeship: Students can apply to enter the Registered Apprenticeship, which is a full-time position at Behavioral Health Network in one of their children & family programs. This is a paid, entry-level employment opportunity that requires 2,000 hours (1 year) to complete the state-recognized Registered Apprenticeship.


Program Commitment
Participation in these grant funded courses requires the ability to commit to completing 2 courses (across 2 consecutive semesters at HCC). The second semester includes a 125 hour practicum placement at a local agency PLUS attendance in the course.  After Year 1, students can apply to the Registered Apprenticeship at BHN, which is a 1-year, paid, full-time position. All students must be interested in and willing to complete the Registered Apprenticeship position. A $5,000 stipend is provided during the CHW classes and a $7,500 stipend is provided during the Apprenticeship.
Please discuss below your understanding of this and how you will be able to commit to attending and completing this program. *
The first CHW class at HCC runs from September -December 2022. This class will occur on 2 weekday evenings each week (class is likely to be In Person). The second class runs from January-May 2023. It will involve two pieces: 1) a 2-hour/week class (likely In Person); and 2) a 125 hours practicum/externship (approx. 9 hours/week) at Behavioral Health Network. Please tell us how this will work for your schedule. *
Computer Skills for Completing Courses
In order to be successful in these classes you must be able to use basic computer programs, such as Word, Excel, Powerpoint, internet, and email, as well as use the computer for research.  
Please respond honestly about whether you have these skills at this point in time: *
Do you have access to a reliable internet for completing homework? *
The field work component of the program takes place at various agency locations in Holyoke and Springfield. Do you have reliable transportation?
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Health Clearances for HTH 209
Participation in the program also requires and meeting immunization requirements for the CHW Practicum Course (HTH 209). This includes: flu, Hep B, MMR, Tdap, Varicella, TB testing, and COVID 19 Vaccination. More information will be provided about how to go about submitting documentation of these requirements.
Please acknowledge that you understand these health clearance requirements. *
Educational Goals
If you are a current HCC student, what is your major?
If you are not a current HCC student, do you have any educational goals, such as seeking a degree? Please explain?
Mandatory Information Session
As one of the enrollment steps, you will need to attend an Information Session to get details about the program and ensure it's a good fit for you.

Information session dates will be scheduled in June 2022.
I understand that participation in a Mandatory Information session is required for enrollment into the program *
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