Community Health Worker Training

Pharmacy-Based Community Health Worker Training

CERTIFICATE PROGRAM ENROLLMENT
The Pharmacy-Based Community Health Worker Certificate Program is a 12-week course that combines live, virtual class meetings with on-demand lessons and assingmnets

Participants must attend all live, virtual classes, complete all reading and homework assignments, and complete 60 hours of resource development activities within their local community.

Complete the following form to enroll in the Pharmacy-Based Community Health Worker Certificate Program.
Select the session for which you wish to register:*

January 28, 2025 - April 15, 2025

Commitment to Participate
The following list includes all requirements for participation in the certificate training program:
- Submit an active email address for a Dedicated Supporter (pharmacist, pharmacy manager, or owner) who will engage with the CHW candidate and provide resources and support for the candidate for the entire length of the program, including any post-reporting or inquiries from program administrators (Dedicated Supporters will be emailed a letter indicating they have been identified as such)
- Commit to completing all course requirements
  - Reading and Assignments - anticipate 2-3 hours of homework per week, including course reading
  - Complete 60 hours of resource development activities outside of regular class time
    
    Please note, each individual learner (in collaboration with their practice site and dedicated supporter) is responsible for identifying their resource development opportunities and coordinating all ssociated logistics. Course facilitators and instructors will provide guidance for identifying resource development opportunities, but learners are ultimately responsible for executing all tasks associated with resource development.
  - Document a minimum of 30 Resources and create a Resource Portfolio to support future work as a CHW.
    
    Please note, guidance for creating a Resource Portfolio will be provided as part of this program.
  - Obtain 2 CHW Core Competency Assessments from points of contact outside the pharmacy
- Commit to attending all live, virtual class sessions. Class meetings are scheduled from 6:00pm-8:00pm CT on the following dates (schedule subject to change):
  - January 28, 2025
  - February 18, 2025
  - March 11, 2025
  - April 1, 2025
  - April 15, 2025
- Provide any required contact and demographic information
- Agree to receive program emails, texts, and other communications to ensure ongoing engagement with the program to assist in continuous improvement of the program and amplification of the impact that the program has in local communities
- Participate in ongoing reporting of outcomes and benefits
- Have access to a computer, tablet, or other device with a camera, microphone, speakers, and internet access to facilitate active engagement during live sessions

Program Requirements
To meet the requirements of this program, I agree to:
- Attend all course meeting times as scheduled. Meetings are held virtually via an online meeting platform every Tuesday evening from 6PM-8PM CST.
- Actively participate in virtual classroom discussions and activities.
- Complete all course work and activities as assigned (anticipate 2-3 hours of homework per week, including course readings).
- Complete 60 hours of resource development (experiential) activities.
  - **Please note, each individual learner, in collaboration with their practice site and Dedicated Supporter, is responsible for identifying their resource development opportunities and coordinating all associated logistics. Course facilitators and instructors will provide guidance for identifying resource development opportunities, but learners are ultimately responsible for executing all tasks associated with resource development.
- Create a Resource Portfolio to support future work as a CHW.
  - **Please note, guidance for creating a Resource Portfolio will be provided as part of the course.
State CHW Certification Attestation
State Certification Attestation*

Registrant Information

Enter your contact information below.
Name*

First NameLast Name
Email*
example@example.com
Personal Mobile Phone*
Please enter a valid phone number. We will not share this number. It will be used solely for the purpose of communication related to this course.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Registrant's Primary Practice Role:*

Pharmacy TechnicianPharmacistOther (please specify)

Personal Statement
Please provide a brief, personal statement about why you want to complete the CHW training. How will you use this training in your community? Please provide 3-5 sentences below.*

Employer's Information

Enter your employer's information below.
Name of Pharmacy or Company*
Employer's NCPDP Provider Identification Numbers (primary practice site)
What is an NCPDP Provider ID Number? The NCPDP Provider ID is a seven-digit numbering system that is assigned to every licensed pharmacy and qualified non-pharmacy dispensing sites (NDPS) in the U.S.
Employer's Street Address (primary practice site)*
City*
State*
Zip Code*
Employer's Phone Number*
Please enter a valid phone number.

Required Materials
The following materials are required for this course:
- Computer, tablet, or other device in good working order
- Camera (embedded within the device is acceptable)
- Microphone (embedded within the device is acceptable)
- Speakers (embedded within the device is acceptable)
- Reliable Internet Access

Textbook Details
The following textbook is required for this course:

Foundations for Community Health Workers; Third Edition (2024), Jossey-Bass Publications; John Wiley and Sons, Inc.

The textbook is included in the course. You have the option of an electronic copy or a printed copy. Please make your selection below:
Please select your preferred type of textbook:*

Electronic Format (readable through the Kindle app on your computer or mobile device)Printed Format (a paperback printed book)

Printed Format
Please enter the mailing address for where your printed textbook should be delivered:
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
If you selected a printed copy of the textbook, what is the address where it should be sent?

Home addressCompany addressNot applicable - I chose an electronic copy of the textbook or I will be purchasing the textbook myself

Scholarship Details
Congratulations! Because your organization is located in Missouri, you are eligible for a full-tuition scholarship from the Missouri Pharmacy Association (a $1,380 value)!

To meet the requirements of the CHW scholarship, I agree to:
- Attend all course meeting times as scheduled. Meets are held virtually via an online meeting platform every Tuesday from 6 pm – 8 pm central time during the dates I have selected for my course*
- Actively participate in virtual classroom discussions and activities.
  Complete all course work and activities as assigned (anticipate 2-3 hours of homework per week, including course readings).
- Complete 60 hours of service-learning activities and create a Resource Guide to support my future work as a CHW. Guidance for identifying service-learning opportunities and creating a Resource Guide will be provided as part of the course.
*Because meetings are held virtually, all attendees must have access to a computer with a built-in camera and microphone as well as a high-speed internet connection.
Please confirm your acceptance of the scholarship terms above:*

Yes! I accept the terms of my scholarship and look forward to getting started!
Select your textbook preference:*

Electronic format - readable through the Kindle app on your computer or mobile devicePrinted format - a paperback printed book
You will receive an email from CEimpact within 3 business days confirming your scholarship and providing instructions for next steps.

Scholarship Code

If you have been given a scholarship code through a partner organization, you'll want to enter this code in the Coupon Code box on the next screen. If you have a scholarship code, DO NOT ENTER credit card details.
Refund/Cancellation Policy

If payment is made via credit card, refund of the enrollment fee is subject to a $100 administrative fee. Refunds will not be issued for any cohort after the second class meeting.

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If you have a scholarship code, please enter it in the Coupon Code box below. If you have a scholarship code, DO NOT ENTER credit card details.

Complete payment below:*

Community Health Worker Training

$1,500.00

Enter coupon

Total

$0.00

Credit Card Details (DO NOT ENTER credit card details if using a scholarship code)
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Click submit to complete your enrollment.
Questions? Email us at CHW@ceimpact.com.
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Pharmacy-Based Community Health Worker Training

Commitment to Participate

Program Requirements

State CHW Certification Attestation

Registrant Information

Personal Statement

Employer's Information

Dedicated Supporter

Required Materials

Textbook Details

Scholarship Details

Scholarship Code

Refund/Cancellation Policy

Cart