CHW Intake - Nevada Community Health Alliance

Contact and location

Start with the best way for NCHA to reach you.

First name *

Last name *

Email address *

Phone number *

Preferred contact method *

Nevada city *

County *

ZIP code *

I am at least 18 years old. *

I am authorized to work in the United States. *

Training and experience

Tell us about your preparation and background.

CHW training status *

Nevada CHW certification status *

Certification number

CHW or related experience *

Highest education completed *

Languages spoken *

Availability and preferences

Help us understand what opportunities may fit.

Goals and confirmation

One last step before submitting your intake.

What are your CHW career goals? *

Relevant skills, lived experience, or other information

Application assistance: If you need an accommodation to complete this intake or participate in NCHA’s application and interview process, email chwintake@nchallc.org.

Résumé (PDF, DOC, or DOCX; 5 MB maximum)Do not upload Social Security cards, identification documents, medical records, financial records, or any document the form does not request.

How did you hear about NCHA?

I certify that the information provided is accurate, authorize Nevada Community Health Alliance, LLC to use it to evaluate potential opportunities, and acknowledge the Privacy Policy and Terms of Use. *

Community Health Worker Intake

Contact and location

Training and experience

Availability and preferences

Goals and confirmation