Request an HR1 Medicaid training on immigrant eligibility changes
The Camden Coalition offers education and technical assistance related to HR1 Medicaid changes affecting immigrant communities and other Medicaid populations. Complete this form to request a presentation.
ORGANIZATION INFORMATION
Organization name
*
Primary contact
*
First Name
Last Name
Job title
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What county or counties do you serve? (Check all that apply)
*
Burlington
Camden
Cumberland
Salem
Statewide
Other
If other, please list additional counties
TRAINING LOGISTICS
Audience: Who will attend the training? (Check all that apply)
Community members
Immigrant community
Healthcare providers
Social workers
Community Health Workers
Faith leaders
Government staff
Other
Estimated attendance
Under 25
26-50
51-100
Over 100
Do you all have other organizations or community members that will be attending the training?
Training format
In person
Virtual only
Hybrid
Training location (if applicable)
Preferred date(s)
Preferred time(s)
Will interpretation be needed?
No
Yes
If yes, please select all that will be needed for interpretation
Arabic
Chinese
Gujarati
Haitian Creole
Korean
Portugese
Russian
Spanish
Vietnamese
Other
If other, please specify
Will you need printed materials?
No
Yes
If yes, please select all that will be needed for printed materials
Arabic
Chinese
English
Gujarati
Haitian Creole
Korean
Portugese
Russian
Spanish
Vietnamese
Other
If other, please specify
TRAINING GOALS
What would you like participants to learn?
Are there specific topics or questions you'd like us to emphasize?
Examples: Immigration eligibility, document submission, privacy concerns, children & pregnant persons, mixed-status families, Marketplace, appeals, helping clients complete forms, etc
Is there anything else we should know?
Submit
Should be Empty: