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National SCDLP Training Program Application

National SCDLP Training Program Description

Program Information

The Sickle Cell Disease Lay Program (SCDLP) is comprehensive skill training and professional development program designed to give aspiring Community Health Worker(CHW) an opportunity to gain knowledge and experience in Sickle Cell Disease (SCD) related social service and healthcare field. The main objective of SCDLP is to provide both classroom and hands on skills training in an effort to assist aspiring community advocates in obtaining gainful employment and success in the workforce as SCD community health workers/promoters. SCDAA has designed a unique CHW/SCD curriculum and will administer a five-week course to incoming trainees. At a minimum, the curriculum will address core CHW functions and competencies, sickle cell disease, data collection and reporting, and patient-centered medical home concepts.

Courses will include:

Primary Health Care and Human Services, Communication, Patient Advocacy, Community Health Education, Capacity Building, Service Skills and Responsibilities, and Sickle Cell 101

Community Health Worker Definition

According to the Rural Assistance Center a CHW is an umbrella term describing community members who assist individuals and communities to adopt health behaviors. They do not require in-depth education. They may work for pay or volunteer in association with a local healthcare system. They usually share ethnicity, language, socioeconomic status and life experiences with community members they serve, and:

Are selected by the community
Answer to the community
Have training in context of interventions
Have training recognized by health services and certification authorities
Do not necessarily have professional or paraprofessional certificated or degreed post-secondary education

Eligibility

SCDLP training is currently available to SCDAA Community Based Organizations (CBOs) members or affiliates, wanting to pursue a career in community health and sickle cell social service. Criteria for admission include:

Must be 18 years or older,
Have a high school diploma, equivalent or higher,
Have a Valid drivers license and transportation,
Must have and maintain auto-liability insurance,
Complete application requirements,
Have a satisfactory driving Record, and
Have a satisfactory criminal background record

Date of Application:*

First Name: *

Middle Name:

Last Name: *

Birth Date *

Street: *

Apartment/Unit:

City: *

State/Province: *

Zip/Postcode: *

Personal Email (Used for Login): *

Work Email: *

Home Phone: *

Cell Phone: *

Date Available:

Social Security No.

Password(Minimum 8 character)*

Confirm Password:(Same as Password) *

Drivers License Number:

Education

1. High School Name: *

Address:*

From:*

To:*

Degree Name:*

Did you graduate?

Yes

Not Selected

2. College Name

Address:

From:

To:

Degree Name:

Did you graduate?

Yes

Not Selected

3. Other

Address:

From:

To:

Degree Name:

Did you graduate?

Yes

Not Selected

Criminal Background History

Have you ever been convicted of any law violations (including moving traffic violations)?

Yes

If you answered yes to the above question, please list all and explain.

Experience

You may select more than one option.

Sickle Cell Disease Community Advocate

I am an individual living with Sickle Cell Disease

I have a family member who has Sickle Cell Disease

I have completed another Community Health Worker Certification Program

Do you presently have CHW work experience or have you taken any CHW courses in the past?

Yes

Not Selected

Other:

Affiliation

Which Community Based Organization (CBO) are you affiliated with?:

Accommodation

If you have a disability that requires us to make a reasonable adjustment to enable you to successfully complete this program, please list below:

Disclaimer And Signature

Applicant Signature: *

Signature Date *

1. Copy of Driver’s License and/or State Identification Card *

2. Copy of Automobile Liability Insurance

I certify that my answers are true and complete to the best of my knowledge. I will complete all requirements related to the Community Health Worker Training.