Reactivate an Expired Community Health Worker Certification

To reactivate an expired Community Health Worker Certificate, you will need to complete and submit an application for reactivation.

Complete reactivation applications must include the following documents:

● Completed application form with a 2x2 passport-style color photo and notary signature.

● Submission of the notarized Criminal Offender Record Information Request Form (CORI).

● Documentation of compliance with the Board’s Continuing Education requirement. A minimum of 15 CEUs for the most recently completed CEU cycle are required.

CEU renewal cycles begin July 31, odd year and end July 30, next odd year.

NOTE: certificate holders are exempt from completing CEUs for the 2019-2021 renewal cycle.

● If you hold, or have ever held, any professional license or certification, you must request and submit a National Practitioner Data Bank-Healthcare Integrity and Protection Data Bank Self-Query. To request a Self- Query, please contact the National Practitioner Data Bank at 1-800-767-6732 or at www.npdb-hipdb.com. Include the ORIGINAL results with this application; keep a copy for your records.

● Check or money order payable to the Commonwealth of Massachusetts. Cash or foreign currency is not accepted. 

● Submission of completed reactivation application and fee acknowledges that the licensee understands and agrees to all provisions herein.  Reactivation applications are void if requirements for reactivation of a Community Health Worker Certification license are not met within one (1) year from the date of Board receipt of this reactivation application.  All fees are non-refundable and non-transferable.

● Reactivation application must be submitted on single-sided paper.

● Retain a copy of the completed reactivation application and related documents for your records. 

Name

Fee

Unit

Renewal for Fully Certified Community Health Workers

$35

Each

Late Renewal Fee

$57

Per late license renewal (in addition to renewal fee)