Scholarship Recipient Survey: Post Completion – Minnesota Community Health Worker Alliance

Thank you for completing the following survey. This information will be used to improve the CHW Certificate curriculum and our scholarship process for upcoming semesters. 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 benefits of CHWTP or any other future programs with the Alliance; please be honest!

Scholarship Recipient Survey: 6 Months Post Completion

Name(Required)

First Last

Address(Required)

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

Email(Required)

Secondary Email

Phone(Required)

What school did you attend for your CHW Certificate?(Required)

Minnesota West Community and Technical College

Normandale Community College

Northwest Technical College

St. Catherine’s University

Saint Mary’s University of Minnesota

Other

Looking back on your time as a CHWTP scholarship recipient, how would you rate your overall experience?(Required)

Very good

Good

Acceptable

Bad

Very bad

What do you think the CHWTP Scholarship could do to improve student experience?(Required)

Since receiving the CHW Certificate, has your employer/position title changed?(Required)

Yes

Unable to find a job as a CHW

Please describe changes to your employer/position title since receiving your certificate.(Required)

Are you currently employed?(Required)

What is your current job title?(Required)

Who is your employer?(Required)

Employer Type:(Required)

Academic Institution

Academic Medical Center

Area Health Education Center

Certified Community Behavioral Health Center (CCBHC)

Community Behavioral Health/Mental Health Center

Community Health Center (CHC)

Critical Access Hospital

Federal Government

FQHC or Look-Alike

Health Department (local/state/tribal)

Hospital (non-academic)

Indian Health Service (IHS)/Tribal/Urban Indian Health Center

Nursing Home

Other Clinical Health Setting

Other Community-Based Organization

Other Long-term Care Facility

Other Specialty Clinic

Private Industry

Private Practice

Residential Living Facility (including independent and assisted living)

Rural Health Clinic

School-based Clinic

State or Local Government

US Armed Forces

Veterans Affairs Healthcare (e.g. VA hospital or clinic)

Pursuing Additional Education or Training

Unsure

N/A

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)

Employment Location Setting (select all that apply)(Required)

Health Professional Shortage Area

Medically Underserved Community

National Health Service Corps (NHSC)-Approved Site

Primary Care Setting

Rural Area

None of the above

N/A

Primary Role/Specialty at Employment Site(Required)

Community Health Worker

Home Health Aide

Doula

Peer Professional

Recovery Coach

Social Services Aide

Health Education

Other

Which of the following are you doing or plan to do:(Required)

Apply for NHSC Loan payment.

Become employed in public health/prevention setting.

Become employed of pursue further training in a medically undeserved community.

Become or pursue further training in a primary care setting.

Become or pursue further training in a rural setting.

Pursue employment as a CHW/HSW.

Remain employed in my organization.

None of the above

N/A

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

Children or Adolescents

Chronically ill

College students

Financially underserved

Geographically underserved

Health Insurance Marketplace eligible Individuals

Individuals experiencing homelessness

Individuals with HIV/AIDS

Individuals with mental illness or substance use disorders

Lesbian/Gay/Bisexual/Transgender

Low income persons/families

Medically underserved

Migrant workers

Military and/or military families

Older adults

People with disabilities

Pregnant women and infants

Refugee Adults

Socio-culturally underserved

Transitional Age Youth (16-25 years)

Tribal Population

Underrepresented minorities

Undocumented Immigrants

Unemployed

Uninsured/Underinsured persons/families

Veterans

Victims of interpersonal violence abuse or trauma

None of the above

N/A

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

Not employed as a Community Health Worker

Address social determinants of health

Advocacy – individual and community

Assessment – individual and community

Capacity building – individual and community

Case management

Collect data and relay information to stakeholders to inform programs and policies

Conduct outreach

Create connections between vulnerable populations and healthcare providers

Determine eligibility and enroll individuals in health insurance plans

Educate healthcare providers and stakeholders about community health needs

Ensure cultural competence among healthcare providers serving vulnerable populations

Help patients navigate healthcare and social service systems

Manage care and care transitions for vulnerable populations

Participate in research and evaluation

Provide coaching and/or informal counseling

Provide cultural mediation among individuals / communities / health and social service systems

Provide culturally appropriate health education

Provide interpretation and translation services

Provide referrals

Provide some direct services such as first aid and blood pressure screening

Reduce social isolation among patients

N/A

May the Minnesota Community Health Worker Alliance contact your employer?(Required)

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

What is your current annual household income?(Required)

Less than $20,000

$20,000- $30,000

$30,000- $40,000

$40,000- $50,000

$50,000- $60,000

$60,000- $70,000

$70,000- $80,000

$80,000- $90,000

$90,000- $100,000

More than $100,000

What is your current family size?(Required)

Have you recieved additional training, beyond the CHW Certificate in any of the following areas:

Public health/ prevention

Medically undeserved community

Primary care setting

Rural setting

None of the above

Please the timeframe that you received your certificate:(Required)

Before July 1 2024

Between July 2 and September 30 2024

Between October 1 and December 31 2024

I do not complete my certificate

Other

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 Minnestoa Department of Health (MDH) and the Health Resources and Services Administration (HRSA) for the purposes of grant reporting, and to the Minnesota Community Health Worker Alliance Education Committee members for the purpose of curriculum review.

I agree

Comments

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

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Scholarship Recipient Survey: 6 Months Post Completion