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Update your CHW Certificate information or request a duplicate

Keep your name, address, and other information up to date with the Board of Certification of Community Health Workers.

Board of Certification of Community Health Workers

The Details of Update your CHW Certificate information or request a duplicate

What you need for Update your CHW Certificate information or request a duplicate

If you are requesting changes online:

You will need your Online Licensing username and password. If you do not have an account yet, you may search for your records with your date of birth and SSN.

You cannot request a name change through the online portal. This must be done via mail.

If you are requesting changes through paper application, you need your:

-License number

-Social Security Number

-Date of birth

For a name change:  You must return the original hard copy of your license and submit a copy of supporting documents. Supporting documents include:

-Marriage certificate

-Divorce decree

-Court documents

-Other documentation

Fees for Update your CHW Certificate information or request a duplicate

For duplicate licenses:

You must pay the duplicate license fee for each license you wish to have duplicated

There are no fees for address changes or name changes with renewal.

Pay by check or money order, payable to the Commonwealth of Massachusetts

Do NOT send cash or electronic funds transfers.

Name

Fee

Unit

Duplicate license

$17

Per license

Name change with new license

$27

Per license

 

How to apply Update your CHW Certificate information or request a duplicate

Download and complete the application, found below

Attach all documentation and fees. Mail to:

Board of Certification of Community Health Workers
239 Causeway St.
Suite 500, 5th Floor
Boston, MA 02114

Please note: name changes must be submitted via mail with applicable attachments

For requesting address changes and/or duplicate licenses, you can login to our Online Licensing portal.

More info for Update your CHW Certificate information or request a duplicate

If you are requesting a name change and you have a current or expired license with another board within the Bureau, the requested name change will be effective for all boards

All addresses are subject to disclosure on request (MGL c. 4, s. 7)

MA Board of Certification of Community Health Workers
239 Causeway St.
S
uite 500
5th Floor
Boston, MA 02114

Downloads for Update your CHW Certificate information or request a duplicate

Contact for Update your CHW Certificate information or request a duplicate

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