Evaluation Worksheet for Certificate		Community Health Worker
SID:	________________________________	Certificate of Achievement - 3303
		Effective: Fall 2017
		Health Sciences
Name:	________________________________	(707) 527-4836

REQUIREMENTS: Complete 27.5 units Community Health Worker Requirements - complete 27.5 units Course Description Units Completed In Progress Comments CHW 150  Introduction to Community Health Work 1.0       CHW 151  Outreach Techniques and Strategies 3.0       CHW 151L  Outreach Experience 3.0       CHW 152  Health Issues and Resources 3.0       CHW 152L  Team Outreach Experience 3.0       CHW 153  Community Health Education 3.0       CHW 154  Disease Prevention and Health Promo Vulnerable Populations 3.0       CHW 155  Mental Health Promotion 2.5       HLE 5  Personal Health and Wellness 3.0         Complete any combination totaling at least 3.0 units from the following: ANAT 58  Introduction to Human Anatomy 3.0       ANAT 40  Introduction to Human Anatomy and Physiology 4.0       ANAT 140  Fundamentals of Anatomy and Physiology 2.0       CHLD 10  Child Growth and Development 3.0       COMM 7  Intercultural Communication 3.0       HLC 140  Health Care Implications of Anatomy and Physiology 1.0       HLC 160  Medical Terminology 3.0       PSYCH 1A  General Psychology 3.0       PSYCH 5  Abnormal Psychology 3.0

	Evaluation worksheet completed upon receipt of Transfer Credit Evaluation form. Includes credit from other institutions only received to date.
	Evaluation worksheet completed for ________________________________. Includes all SRJC and transfer credit received to date.

Units completed:    __________ Units in progress:    __________ Total:    __________

Requirements Completed     Pending (work in progress)     Requirements Not Completed

Comments

Date: ________________________   By: ____________________________________________