Everything You Need to Know about LGBTQIA+ Programs and Health Services

Stay Tuned!

Applications are currently closed for the 2025 cohort.

Application

First Name:

Last Name:

Pronouns:

Home Address:

Date of Birth:

Highest Level of Education:

Email:

Phone:

Preferred Method of Contact:

Phone

Text

Why are you interested in pursuing the Health Collective's Community Health Worker Program?

How do you plan to use this certification upon course completion?

Do you have reliable transportation to attend classes and program events?

Yes

Statement of Understanding

I understand that this form serves to demonstrate my interest in the Health Collective's Community Health Worker program. If selected, I will be invited to attend an informational seminar, and this does not guarantee acceptance into the program itself. Final acceptance into the program will be determined after the seminar and completion of any additional steps in the selection process.