CCHW Training Registration

The $1,500 fee includes instruction materials (books and student manual), registration, examination, and 1-year Indiana Community Health Worker Association membership.

Personal Information

(please list your name as you would like it to appear on your certificate)

Employment

Education

(Please select highest level of education)

Race/ Ethnicity

(Check all that apply)
By clicking the box I certify that the information given is current and accurate to the best of my knowledge. Upon successful training completion your name printed on certificatesBy clicking the box I certify that the information given is current and accurate to the best of my knowledge. Upon successful training completion your name printed on certificates as it appears on this registration form. as it appears on this registration form.

Once you submit this form you will be forwarded to a secure payment portal to finish your registration.

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