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COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES DEPARTMENT OF PUBLIC HEALTH BUREAU OF HEALTH PROFESSIONS LICENSURE BOARD OF CERTIFICATION OF COMMUNITY HEALTH WORKERS https://www.mass.gov/dph/boards(617)9730800

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What is chw-individual-application 12- restructure?

The chw-individual-application 12- restructure is a form used to make changes or updates to an individual's Community Health Worker (CHW) application.

Who is required to file chw-individual-application 12- restructure?

Any individual who needs to restructure or update their CHW application is required to file chw-individual-application 12- restructure.

How to fill out chw-individual-application 12- restructure?

To fill out the chw-individual-application 12- restructure, the individual must provide the necessary information requested on the form and submit it according to the instructions provided.

What is the purpose of chw-individual-application 12- restructure?

The purpose of the chw-individual-application 12- restructure is to ensure that accurate and up-to-date information is maintained for Community Health Workers.

What information must be reported on chw-individual-application 12- restructure?

The information to be reported on chw-individual-application 12- restructure may include personal details, contact information, employment history, training certifications, and any updates or changes since the initial application.

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