Leadership Institute: 2025 Application – Minnesota Community Health Worker Alliance

The application period for the 2025 Leadership Institute is now closed. Please sign up for our newsletter to get updates about future opportunities. Questions? Rachel Stoll (Rachel@mnchwalliance.org)

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Leadership Institute Application

Name(Required)

First Last

Resume(Required)

Please upload a copy of your resume

Max. file size: 50 MB.

Home Address(Required)

City State ZIP Code

Phone(Required)

Email(Required)

What year were you born?(Required)

What is your race? (select all that apply)(Required)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

What is your ethnicity?(Required)

Hispanic or Latino

Not Hispanic or Latino

What is your gender?(Required)

Man

Woman

Non-binary

Transgender

Please list any languages that you speak or read other than English (if you only read and speak English, write 'none').(Required)

Veteran Status(Required)

Not a Veteran

National Guard

Reservist

Veteran- Prior Service

Veteran- Retired

What year did you start your career as a CHW?(Required)

Are you a Minnesota Community Health Worker Certificate holder?(Required)

Yes

I am currently enrolled in a CHW Certificate program

Other

What year did you recieve your CHW Certificate?(Required)

What school did you attend to get your certificate?(Required)

Minnesota West Community and Technical College

Northwest Technical College

Normandale Community and Technical College

St. Catherines University

Saint Mary’s University of Minnesota

Other

Employment status(Required)

Employed in a CHW role

Employed in a role similar to a CHW

Employed in a role that is unrelated to the CHW role

Not currently employed

Other

Who is your employer?(Required)

What is your job title(Required)

County or Tribal Nation of employer(Required)

Supervisor Name(Required)

First Last

Supervisor Job Title and credentials (i.e. CHW, MPH, RN etc.)(Required)

Supervisor Email(Required)

Please upload a letter of recommendation from you supervisor

Max. file size: 50 MB.

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

40 hours or more per week

30-40 hours per week

Less than 30 hours per week

Currently not working as a CHW

Other

Are there any special needs or accommodations that would make is easier for you to participate in the Leadership Institue?(Required)

Please select all dates that you are ABLE to participate in the Leadership Insitute in-person in St. Paul Minnesota(Required)

April 8 2025

September 9 2025

Application Questions

Please answer each question below in 250 words per question (1250 characters max). You may type your answers into the boxes.

Why have you become a CHW?(Required)

Why are you interested in participating in the CHW Leadership Institute?(Required)

How do you hope to grow and benefit from the program? What are your thoughts on how you would like to put your leadership skills to use?(Required)

Briefly highlight any community and volunteer involvement including any past or current leadership roles (e.g. school, cultural group, neighborhood, faith-based group)(Required)

Briefly list how you are involved in the CHW field (such as the work of the MN CHW Alliance, attending educational programs of the MN CHW Peer Network, etc).(Required)

Briefly, in a few sentences, what else would you like us to consider in the evaluation of your application?(Required)

Consent(Required)

I understand that the MN CHW Alliance may select only a specific number of participants. If I am selected, I agree to the following:

1. I will actively participate in the CHW Leadership Program including all sessions and required activities/assignments including a brief program evaluation.

2. I understand that I must attend all sessions in order to receive a Certificate of Completion.

3. Building on my leadership skills. I am committed to stepping into future leadership and representational roles as a CHW.

I agree

Consent(Required)

By checking this box, I give permission to the Minnesota Community Health Worker Alliance to share de-identified information in this form with the Minnesota Department of Health (MDH) for the purposes of grant reporting.

I agree

Phone

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

Leadership Institute Application

Name(Required)

First Last

Resume(Required)

Please upload a copy of your resume

Max. file size: 50 MB.

Home Address(Required)

City State ZIP Code

Phone(Required)

Email(Required)

What year were you born?(Required)

What is your race? (select all that apply)(Required)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

What is your ethnicity?(Required)

Hispanic or Latino

Not Hispanic or Latino

What is your gender?(Required)

Man

Woman

Non-binary

Transgender

Please list any languages that you speak or read other than English (if you only read and speak English, write 'none').(Required)

Veteran Status(Required)

Not a Veteran

National Guard

Reservist

Veteran- Prior Service

Veteran- Retired

What year did you start your career as a CHW?(Required)

Are you a Minnesota Community Health Worker Certificate holder?(Required)

Yes

I am currently enrolled in a CHW Certificate program

Other

What year did you recieve your CHW Certificate?(Required)

What school did you attend to get your certificate?(Required)

Minnesota West Community and Technical College

Northwest Technical College

Normandale Community and Technical College

St. Catherines University

Saint Mary’s University of Minnesota

Other

Employment status(Required)

Employed in a CHW role

Employed in a role similar to a CHW

Employed in a role that is unrelated to the CHW role

Not currently employed

Other

Who is your employer?(Required)

What is your job title(Required)

County or Tribal Nation of employer(Required)

Supervisor Name(Required)

First Last

Supervisor Job Title and credentials (i.e. CHW, MPH, RN etc.)(Required)

Supervisor Email(Required)

Please upload a letter of recommendation from you supervisor

Max. file size: 50 MB.

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

40 hours or more per week

30-40 hours per week

Less than 30 hours per week

Currently not working as a CHW

Other

Are there any special needs or accommodations that would make is easier for you to participate in the Leadership Institue?(Required)

Please select all dates that you are ABLE to participate in the Leadership Insitute in-person in St. Paul Minnesota(Required)

April 8 2025

September 9 2025

Application Questions

Please answer each question below in 250 words per question (1250 characters max). You may type your answers into the boxes.

Why have you become a CHW?(Required)

Why are you interested in participating in the CHW Leadership Institute?(Required)

How do you hope to grow and benefit from the program? What are your thoughts on how you would like to put your leadership skills to use?(Required)

Briefly highlight any community and volunteer involvement including any past or current leadership roles (e.g. school, cultural group, neighborhood, faith-based group)(Required)

Briefly list how you are involved in the CHW field (such as the work of the MN CHW Alliance, attending educational programs of the MN CHW Peer Network, etc).(Required)

Briefly, in a few sentences, what else would you like us to consider in the evaluation of your application?(Required)

Consent(Required)

I agree

Consent(Required)

I agree

Phone

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

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Leadership Institute Application

Application Questions

Leadership Institute Application

Application Questions