Training Program Initial Application Intake Form

Thank you for your interest in the Community Health Worker (CHW) Training Program application for initial certification by the Illinois Department of Public Health (IDPH). Please complete this brief form to determine if your training program meets the minimum eligibility criteria to apply. After you complete this intake form and if eligible, you will receive an application link for the CHW Training Program Certification.  

1. Organization Type

Please select the category that best describes your organization:
Is the training program an instructional partner for a CHW apprenticeship program?
Note that the application must be filled out by the instructional partner, not the apprenticeship program.

2. Curriculum Requirements

Does your curriculum include a minimum of 100 hours of classroom instruction?
Does your curriculum cover all 9 core competencies as defined by the Illinois Department of Public Health (IDPH)? [insert link to core competencies]
Does it include at least 5 hours dedicated to each core competency #1-9?
Does your program include at least 80 hours of field experience?

3. Program Readiness

Do you have qualified instructors with experience in CHW training?
Do you have a process in place to assess CHW learners’ competency (e.g., exams, evaluations, field assessments)?
Is your program currently active or in development?

When does the program plan to launch?

4. Contact Information