Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

In what capacity have you attended births? *

Friend/Family

Nurse

Doula

N/A

Part 1 of Training *

Part 1: 14 On-demand Modules: There are pre-recorded modules that participants will first complete over a specified time frame. These modules provide content that is foundational to being a Doula which participants can access at their own pace and in times that are suitable to them. These modules should be completed before the live training.

I understand that all 14 modules must be completed before the in person training August 2, 2024

No, I can't commit

Part 2 of Training *

Part 2: 3 Days of Live Training: These live training sessions solidify skills while allowing for group discussions, small group work, and Q&A periods. Live training days are: Friday, August 2, 2024 (9am-5pm) Saturday, August 3, 2024 (9am-5pm) Sunday, August 4, 2024 (9am-5pm)

Yes, I understand and I will be available to attend the 3 day in person training 8-2-24, 8-3-24 and 8-4-24

No. I can't commit

Part 3 of Training *

Part 3: Six Months of Mentorship: While participants complete the requirements for certification (including supporting 5 families through childbirth, required reading, and creating a community resource list), they will have access to the instructor/mentor in group circles and one-on-one. During this period, continuing education will also be offered to further develop understanding and skills in areas such as pregnancy complications, mental health, breastfeeding support and providing childbirth education.

Yes, I understand in order to complete the requirements for certification I have to: support 5 families through childbirth, required reading, and creating a community resource list.

I can't commit

Location of Training *

Hanover, MD

I am available and willing to travel to Hanover, MD all three days of live in person training 8/2/24-8/4/24

I can't commit

Payment and refunds *

The cost of this training is $900. If selected for the scholarship recipients will pay $450.00 towards their training, due by April, 5,2024. Refunds: If you are unable to attend the live training you can talk directly with Commonsense Childbirth to reschedule for a different date, time and location. This is non refundable

I understand this is a half scholarship and will be able to pay $450 by 4/5/2024 should I receive the scholarship. I also understand this is non refundable if I'm unable to attend and will reach out to Commonsense Childbirth to reschedule

I can't commit