CHWP Training Academy- Spring 2023 Pre-Screen Application

Thank you for your interest in the Community Health Worker Peer/ Certified Peer Specialist Training Academy, a program of Drexel University Center for Nonviolence and Social Justice.

Drexel University is able to offer the Community Health Worker/Certified Peer Specialist Training Academy for free thanks to funding from the Workforce Innovation and Opportunity Act (WIOA) Youth Program. This screening form asks for information to determine if you are eligible to participate in the WIOA Youth Program. This screening form is administered in RedCAP, a secure online data collection platform.

Completing this screening form is optional. If you choose not to complete the screening form, Drexel University will be unable to assess your eligibility for the Community Health Worker/Certified Peer Specialist Training Academy. Any other services you are receiving from Drexel University will not be affected in any way.

If you have any questions or need assistance to complete the form, please contact Aunnalea Grove at 267-441-5778 or aeg336@drexel.edu.

Consent Form

I understand that if I am accepted as a participant of this Program, I will receive a training stipend from Drexel University for the duration of my participation in the training. I also understand that as the training provider, Drexel would not otherwise have knowledge of the information that I am providing on this ​form.​ I consent for Drexel University to collect the information in this form for the sole purpose of verifying eligibility for the WIOA Youth Program.