We now have a “Commit To Purchase” agreement that can be used by organizations to expedite membership to KYACHW for current and new CHW hires. 

THANK YOU FOR SUBMITTING YOUR MEMBERSHIP APPLICATION! Welcome to our secure online processing system.  Select the payment you would like to make below.
Payment Options
You may also mail your check or money order to: KYACHW 750 Morton Blvd. Hazard, KY 41701 * Your membership will not be confirmed until your check is received in our office. *

****Please read carefully in regards to payment toward membership for another CHW. We are working on a better way to work on payment, but as of now, you will need to change the “Ship To” name to the CHW you are paying for. Sorry for any inconvenience or confusion this may have caused with payment. If you have questions or need assistance in this, you can contact Kala Gilliam kgi232@uky.edu.  *****

Commit To Purchase Agreement Form

COMMIT TO PURCHASE IS FOR ORGANIZATIONS ONLY, NOT FOR INDIVIDUALS!! 

Once you have downloaded and completed the “Commit To Purchase” form, please email it to our KYACHW Secretary Shirley Prater at sdpr223@uky.edu.

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