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Toggle Navigation
Who We Are
About Us
Our History
Our Staff
Board of Directors
Clinical Providers
Employment
ASPIN Programs
ASPIN Training
Community Health Worker Training and Certification Overview
Community Health Worker/Peer Recovery Support Specialist Training and Dual Certification
ASPIN’s Behavioral Health Workforce Education and Training Program for Paraprofessionals
ASPIN’s Opioid Impacted Family Support Program
Health Navigator
Workforce Innovation Project
ASPIN’s RCORP Pathways Program
Contact Us
ASPIN Private Tuition Training Application
Brittney Isley
2026-02-12T15:33:04-05:00
ASPIN Private Tuition Training Application
Please enable JavaScript in your browser to complete this form.
CHW Training Funding:
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My organization will be paying for my training. (Checks or credit cards accepted)
I will be paying for my training. (credit card only)
I would like to apply for a scholarship to pay for my training.
If you or your organization will be paying for the training please provide the email address of where the invoice should be sent:
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If your organization will be paying for the training please provide the name of the invoice contact:
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If your organization will be paying for the training please provide the name of the organization:
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If your organization will be paying for the training please provide the address of the organization:
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ASPIN’s training scholarship application is currently closed. Sign up for our E-Mail List to Receive Information Regarding ASPIN and ASPIN Training
HERE
Trainings I would like to enroll in:
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Certified Community Health Worker Training ($1,250)
Certified Community Health Worker/Certified Peer Recovery Support Specialist Training ($1,550)
Chronic Care Training ($1,000)
Opioid Basics Training ($1,000)
Opioid Impacted Family Support Training ($1,000)
Introduction to Domestic Violence ($1,000)
Youth Mental Health ($1,000)
Date of Application:
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Student Name:
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First
Last
Home Address:
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City:
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State:
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Zip Code:
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Indiana County:
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Primary Phone:
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Secondary Phone:
Email Address:
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Alternative Email:
Do you have lived experience with substance use and/or co-occurring mental health disorders.
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Yes, personal experience.
Yes, family experience.
Yes, both personal and family experience.
No
I have at least 2 years of recovery from lived experience in substance use and/or co-occurring mental health disorders.
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Yes
No
Are you a current resident of the state of Indiana?
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Yes
No
Are you over the age of 18?
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Yes
No
Have you or a family member served in the U.S. Military? (check all that apply)
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I have served in the military.
I have a family member who has served in the military.
None of the above.
Branch of Service:
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Do you speak any languages other than English?
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Yes
No
If yes, which language(s) do you speak?
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Do you have a high school diploma or equivalent?
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Yes
No
Highest Level of Education:
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Working towards HS diploma or GED
GED
High School Diploma
Associates Degree
Bachelor’s Degree
Master’s Degree
Doctorate Degree
Are you enrolling in this training through an Excel Center?
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Yes
No
Excel Center Coach Name:
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Excel Center Coach Email:
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Excel Center Coach Phone Number:
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What is your expected high school graduation date?
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Do you own or have access to a computer?
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Yes
No
Do you have access to the internet?
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Yes
No
Are you currently employed?
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Yes
No
If yes, Employer
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If yes, Position/Title:
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If yes, Employer County:
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Current Wage:
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Supervisor Name:
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Supervisor Email:
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Are you currently employed as a Community Health Worker?
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Yes
No
Have you ever been certified as a Community Health Worker?
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Yes
No
Have you completed any other type of Community Health Worker Training?
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Yes
No
How many years of experience do you have working in the Mental Health Field?
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How many years of experience do you have working in the Addiction Field?
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How many years of experience do you have working with chronic health conditions?
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How many years of experience do you have working in a role comparable to a Community Health Worker?
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Why would you like to become a Community Health Worker?
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What makes you a good candidate to serve your community as a Community Health Worker?
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Language Preference:
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English
Spanish
How did you hear about the ASPIN CHW training?
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We have found that free email accounts like Gmail and Yahoo mail tend to block many email addresses. To ensure that you receive the necessary emails (including a reply to this application) from ASPIN instructors, if you are using accounts from those providers, we request that you read and follow the procedures listed at https://aspin.org/wp-content/uploads/2026/04/Email-Whitelist-Instructions-04.2026.pdf. Please sign your name below to acknowledge this procedure.
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Clear Signature
I attest that I have given true, accurate, and complete information on this form to the best of my knowledge and understand any false information or omissions may affect my eligibility for certification.
Signature:
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Clear Signature
Date:
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Submit
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