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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
CHW Renewal Application
Brittney Isley
2026-02-12T15:29:16-05:00
CHW Renewal Application
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Step
1
of 2
Date:
*
Name:
*
Home Street Address:
*
City:
*
State:
*
Zip Code:
*
County:
*
Telephone:
*
Email Address:
*
Currently Employed:
*
Yes
No
Name of Employer:
*
Employer Address:
Employer City:
Employer State:
Employer Zip Code:
Position Title:
*
County of Employment:
*
Are you currently Employed as a Community Health Worker:
*
Yes
No
Are you billing as a CHW?
*
Yes
No
N/A
If not, what title are you billing under?
Have you been promoted or received a raise because you received the CHW certification?
*
Yes
No
N/A
If you were unemployed, have you been able to get a job because of the CHW Certification?
*
Yes
No
N/A
Do you have lived experience with mental illness or substance abuse?
Personal
Family member
Friend
None
Next
Continuing Education (CEU) Record
Continuing Education Units (or CEUs) are critical to maintaining professional knowledge in a career as a Community Health Worker. CEUs include time spent learning about mental health, substance use, ethics, and other related topics. CEUs DO NOT include time spent in an employment and/or volunteer position. CEUs are measured in hours (1 hour of learning = 1 hour of CEU). CHW’s are required to complete 14 CEUs each year to maintain their certification.
Continuing Education (CEU) #1
Training Date:
*
Provider/Agency:
*
Instructor/Presenter:
*
Training Title:
*
Training Topics:
*
Mental Health
Substance Use
Ethics
Cultural Competence
Environmental Health
Chronic Diseases
Food/Nutrition
Other
CEU Hours:
*
Continuing Education (CEU) #2
Training Date:
Provider/Agency:
Instructor/Presenter:
Training Title:
Training Topics:
Mental Health
Substance Use
Ethics
Cultural Competence
Environmental Health
Chronic Diseases
Food/Nutrition
Other
CEU Hours:
Continuing Education (CEU) #3
Training Date:
Provider/Agency:
Instructor/Presenter:
Training Title:
Training Topics:
Mental Health
Substance Use
Ethics
Cultural Competence
Environmental Health
Chronic Diseases
Food/Nutrition
Other
CEU Hours:
Continuing Education (CEU) #4
Training Date:
Provider/Agency:
Instructor/Presenter:
Training Title:
Training Topics:
Mental Health
Substance Use
Ethics
Cultural Competence
Environmental Health
Chronic Diseases
Food/Nutrition
Other
CEU Hours:
Continuing Education (CEU) #5
Training Date:
Provider/Agency:
Instructor/Presenter:
Training Title:
Training Topics:
Mental Health
Substance Use
Ethics
Cultural Competence
Environmental Health
Chronic Diseases
Food/Nutrition
Other
CEU Hours:
Continuing Education (CEU) #6
Training Date:
Provider/Agency:
Instructor/Presenter:
Training Title:
Training Topics:
Mental Health
Substance Use
Ethics
Cultural Competence
Environmental Health
Chronic Diseases
Food/Nutrition
Other
CEU Hours:
Continuing Education (CEU) #7
Training Date:
Provider/Agency:
Instructor/Presenter:
Training Title:
Training Topics:
Mental Health
Substance Use
Ethics
Cultural Competence
Environmental Health
Chronic Diseases
Food/Nutrition
Other
CEU Hours:
Continuing Education (CEU) #8
Training Date:
Provider/Agency:
Instructor/Presenter:
Training Title:
Training Topics:
Mental Health
Substance Use
Ethics
Cultural Competence
Environmental Health
Chronic Diseases
Food/Nutrition
Other
CEU Hours:
Continuing Education (CEU) #9
Training Date:
Provider/Agency:
Instructor/Presenter:
Training Title:
Training Topics:
Mental Health
Substance Use
Ethics
Cultural Competence
Environmental Health
Chronic Diseases
Food/Nutrition
Other
CEU Hours:
Continuing Education (CEU) #10
Training Date:
Provider/Agency:
Instructor/Presenter:
Training Title:
Training Topics:
Mental Health
Substance Use
Ethics
Cultural Competence
Environmental Health
Chronic Diseases
Food/Nutrition
Other
CEU Hours:
Continuing Education (CEU) #11
Training Date:
Provider/Agency:
Instructor/Presenter:
Training Title:
Training Topics:
Mental Health
Substance Use
Ethics
Cultural Competence
Environmental Health
Chronic Diseases
Food/Nutrition
Other
CEU Hours:
Continuing Education (CEU) #12
Training Date:
Provider/Agency:
Instructor/Presenter:
Training Title:
Training Topics:
Mental Health
Substance Use
Ethics
Cultural Competence
Environmental Health
Chronic Diseases
Food/Nutrition
Other
CEU Hours:
Continuing Education (CEU) #13
Training Date:
Provider/Agency:
Instructor/Presenter:
Training Title:
Training Topics:
Mental Health
Substance Use
Ethics
Cultural Competence
Environmental Health
Chronic Diseases
Food/Nutrition
Other
CEU Hours:
Continuing Education (CEU) #14
Training Date:
Provider/Agency:
Instructor/Presenter:
Training Title:
Training Topics:
Mental Health
Substance Use
Ethics
Cultural Competence
Environmental Health
Chronic Diseases
Food/Nutrition
Other
CEU Hours:
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