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WI CHW Network Co-Chair Information


This form is used as an application to apply to serve a 2-year term as a c-chair on the WI CHW Network Committees . Please note the following requirements:
*Must be available to attend and co-facilitate meeting on a quarterly basis in the afternoon.
*Meetings will be facilitated remotely via Zoom.
*The Committees encourage representation from diverse members of the WI CHW Network regions.
*Each committee must have at least one CHW as co-chair.
*If you are not a CHW, you can still apply and serve as an ally
*Must contribute to association activities and be present at special events (ex: annual conference) and other projects when needed.

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your email address?

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* 4. What is your phone number?

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* 5. What is your address?

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* 6. What is your Organization/Agency name?

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* 7. Did you complete the Community Health Worker training?

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* 8. Why are you interested in serving as a co-chair of the WI CHW Network?*

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* 9. Describe your skills and leadership experience

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* 10. Describe ideas you have that will help grow the WI CHW Network

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* 11. Describe your availability to attend and co- facilitate Committee meetings?

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* 12. Please copy and paste your resume here (don't worry about the layout):

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