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SPSI Forms

The Minnesota Community Health Worker Alliance’s (Alliance) will be providing support and resources for you and your family as you complete the Community Health Worker (CHW) Certificate program.  

We invite you to take this survey to help us understand how we can support you while also helping us evaluate our program. We will ask you to take a similar survey towards the end of the program. 

The Alliance staff, who are CHW certificate holders, will have access to your responses. They will only use your survey responses to follow up with you about potential resources that may be of interest to you. 

The Alliance will then remove any identifying information from your survey data and will share with our external evaluator, Professional Data Analysts. They will be responsible for analyzing data and reporting to our funder, but your names and identity will not be shared with them or in any of our evaluation reports. Rather the data will be aggregated or combined across students to share outcomes of this program. The evaluation will help us understand how well we supported student parents, how the support affected CHW certificate completion rates, and how we can improve our support in the future.  

The survey should only take ~15-20 minutes. We ask that you answer the questions honestly and to the best of your ability, so that we may best support you through the CHW certificate program. Please complete this survey by January 31st 2026.  

If you have any questions about the survey or how the data will be used, please contact us at info@mnchwalliance.org.

SPSI Intake Survey

Housing Status


Food

Please answer whether the statements were OFTEN, SOMETIMES, or NEVER true for you and your household in the last 6 months.


Transportation


Utilities


Financial Stability


Childcare


Safety


YesNoDon’t know/Not SureNot ApplicablePrefer not to answer
At home
At work
At school
In our community
With family
YesNoDon’t know/Not SureNot ApplicablePrefer not to answer
At home
At school
In our community
With family

General Health


Physical Health


Mental Wellbeing


Navigating Resources


Very confidentMostly confidentSomewhat confidentNot at all confidentDon’t know/ Not sure
How confident are you in balancing your studies with family, work, and other responsibilities?
How confident are you in finding and navigating resources to support yourself and your household?
How confident are you in finding and navigating resources to support your education?
Very likelyMostly likelySomewhat likelyNot at all likelyDon’t know/ Not sure
How likely are you to use resources to support yourself and your household?
How likely are you to use resources to support your education?

Support


Monthly Cohort Meetings