Colorado Health Navigator Registry Application

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First name *

Last name *

Email address *

Zip code *

Employer *

Employer Address *

Eligibility *

I completed training from a recognized training program and have sent a copy of my certificate(s) of completion to cdphe_health_navigator@state.co.us.

Training program completed *

Patient Navigator Training Collaborative (provide Level 1, Care Coordination and Basic MI certificates)

Otero Junior College

Boomers Leading Change

Metro State University

CU Multidisciplinary Center on Aging

Asssement Option *

Virtually

In-Person

Declaration *

I attest that I am at least eighteen (18) years old

Required

Initials *

I hereby request to be placed on the Colorado Health Navigator Registry. I am aware that my name and zip code will be public information. It is my responsibility to notify Colorado Department of Public Health and Environment if I wish to be taken off of the registry.

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