CSU Alert

Berkman Hall and the Student Center ARE OPEN Wednesday, Sept. 23. The water main break has been repaired. Some elevators and the lower level of the Main Garage remain closed. Please check your CSU email for detailed information.

Community Health Worker Program Application

Name

Title

First

Middle

Last

Suffix

Birthdate

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email confirm

Confirm email

Phone

Citizenship

US Citizen

I am a US Citizen

Not a US Citizen

I am not a US Citizen, but am an eligible non-citizen

Resident of Cuyahoga County

I am a resident of Cuyahoga County (priority given to residents of Cuyahoga County)

Readmission

I am applying for readmission into the program (please provide a letter stating the reason for your withdrawal and any changes you've made to ensure success on your next attempt).

Essay

Please upload a 300 word (minimum) essay describing all past/current service in your community, your future goals/plans and how this program fits into that plan, and how you will fit the 14 Saturday classes, 4 days of CDSM training, and 130 service hours into your current schedule. If you have difficulty uploading your document, you may alternatively email to cenursing@csuohio.edu

One file only.
100 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.