Community Health Worker Program

Colette Lamothe-Galette (CLG) Community Health Worker Application

NJ Department of Health (NJDOH) has established the Colette Lamothe-Galette (CLG) Community Health Worker Institute through a NJ Department of Labor (NJDOL) Apprenticeship program.
Date*

MonthDayYear
Date
Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Gender*
Cell Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
Race*
Ethnicity*
Highest Level of Education Achieved*
Are you currently employed?*
Name of Employer*
Choose a preferred class option*

Class date 10/16/23-2/19/24; 9am-1pmOther
Select a preferred time*

MorningAfternoonEvening
Comments or Questions
The NJ Department of Health (NJDOH) has established the Colette Lamothe-Galette (CLG) Community Health Worker Institute. The goal of the Institute is to create a standardized community health worker training and certification program, resulting in a robust CHW workforce. This will allow the state to educate an emerging and critical component of its workforce – creating a needed infrastructure to support CHWs, and the institutions they serve. Through this work, the NJDOH will create career pipelines for CHWs, enhance CHW skill sets and lead sustainable efforts to support this indispensable workforce.
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Colette Lamothe-Galette (CLG) Community Health Worker Application