Fall 2023 Scholarship Recipient Survey: End of Semester 2

Thank you for completing the following survey. This information will be used to improve the CHW Certificate curriculum and our scholarship process for Fall 2024. The information in this form will be de-identified (all personal information removed) and shared with the Minnesota Community Health Worker Alliance Education Committee for the purpose of curriculum improvement and the Minnesota Department of Health and the Health Resources and Services Administration for the purpose of grant reporting. Your answers in this survey will not affect your ability to continue to receive the CHWTP scholarship; please be honest!

Name(Required)

First Last

Email(Required)

Secondary Email

From your perspective, is the CHW certificate program content and delivery appropirate for preparing students to work with various cultural communities?(Required)

Yes

Unsure

Neutral

What could the program do to improve content and delivery to prepare students to work with various cultural groups?(Required)

What does the program do best for preparing students to work with various cultural groups?(Required)

Are you currently employed?(Required)

What is your current job title?(Required)

Who is your employer?(Required)

Employer type:(Required)

Address of employer(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

How many hours a week do you work?(Required)

40 hours or more per week

30-40 hours per week

Less than 30 hours per week

Currently not working

Other

What is your hourly wage?(Required)

Is your current employer your field experience/ internship site?(Required)

Yes

I have not yet started field experience/internship

What organization(s) are you completing your field experience?(Required)

What is your field experience site address?(Required)

Street Address Address Line 2 City State ZIP Code

What is your role/title at your field experience site?(Required)

Field experience site type:(Required)

Have you recieved training in the following settings and/or with the following topics (check all that apply):(Required)

Integrated or interprofessional team-based care

Tele-health

Primary Care setting

None of the above

How much time (of your 80 hour field experience) did you spend training for work within an integrated or interprofessional team or working within an integrated or interprofessional team?(Required)

How much time (of your 80 hour field experience) did you spend training for working in a Primary Care setting?(Required)

How much time (of your 80 hour field experience) did you spend training for working with tele-health?(Required)

During your 80 hour field experience, how many patient/client contact hours have you had?(Required)

Select Type(s) of Vulnerable Populations Served at field experience site (select all that apply)(Required)

Select your primary role at field experience site: (select all that apply)(Required)

May the Minnesota Community Health Worker Alliance contact your field experience site?(Required)

Field experience contact: please provide name, title and email or phone number

What is your current annual household income?(Required)

What is your current family size?(Required)

What are your plans after you receive your CHW Certificate?(Required)

Become employed in a public health/ prevention setting

Become employed or pursue further training in a medically underserved community

Become employed or pursue further training in a primary care setting

Become employed or pursue further training in a rural setting

Pursue employment as a CHW

Remain employed in your current organization

None of the above

Please select all of the competencies that you feel you are highly ready to preform:(Required)

Please select all parts of your CHW Certificate training that you were highly satisfied with (select all):

Quality of experiential training

Quality of instruction for CHW Competencies

Quality of instruction for public health competencies

Quality of mentoring and support services for attaining certificate

Quality of mentoring and support services for employment readiness

Quality of mentoring and support services for job placement

None of the above

N/A

Please the timeframe that you anticipate that you will complete your certificate:(Required)

Before July 1 2024

Between July 2 and December 31 2024

After December 31 2024

I do not anticipate completing my certificate

Other

Name

This field is for validation purposes and should be left unchanged.

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Fall 2023 Scholarship Recipient Survey: End of Semester 2