Maine Community Health Workers (MECHW) Certifications Application

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This application form will allow you to apply for the certification status listed below by providing a way to upload the required documentation and pay the required assessment fee. Please have the documentation and payment ready in order to complete the application. Refer to the MECHW website for additional information regarding the requirements. MECHW CERTIFICATION WEBSITE

Initial Certification (Fee $100) Required Documentation:

● Age verification

● Verification of high school diploma, HiSET™, or higher.

● Verification of completion of 40 hours of an approved training program

● Verification of completion of a minimum of 1000 service hours within 2 years
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Full Name* This field is required.
First Name
Last Name
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Email Address* This field is required.
example@example.com
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Phone Number* This field is required.
Please enter a valid phone number.
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I am 18 years or older.* This field is required.Candidate must be 18 years or older at time of application.
Yes
No
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I have a high school diploma, HiSET™, or higher.* This field is required. Candidate must have earned a high school diploma, HiSET, or higher.
Yes
No
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I have completed 40 hours of an approved training.* This field is required.Candidate must complete 40 hours of an approved training program based on the C3 Project core competencies endorsed by the Maine CHW Initiative.
Yes
No
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I have completed 1000 service hours.* This field is required.Candidate must complete a minimum of 1000 service hours. Please see the website for additional information.MECHW CERTIFICATION WEBSITE
Yes
No
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I attest that I have read and accept the MECHW code of ethics.* This field is required.Candidate must attest to the MECHW code of ethics. Please click here to review the code of ethics CHW Code if Ethics
Yes
No
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Please upload all required documentation.* This field is required.Initial Certification - Required documentation ● Age verification ● Verification of High School diploma, HiSET, or higher ● Verification of completion of 40 hours of an approved training program ● Verification of completion of a minimum of 1000 service hours within 2 years
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All documentation must be uploaded in order to apply. Indicate the documents that you have uploaded by checking the boxes below.
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Fees* This field is required.
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You do not currently meet the application requirements. Please refer to the Maine Community Health Workers website for specific application requirements.
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