Application for San Diego Breastfeeding Coalition Lactation Scholarship

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please fill out this form to complete the application.

Email *

Name *

Phone *

Address *

Select Desired Program: *

Lactation Education Counselor

Lactation Consultant Pathway 1

Lactation Consultant Pathway 2

Required

Please tell us what languages you fluently speak *

Education (Include Dates) *

Credentials *

Work Experience (include dates): *

Volunteer Experience (include dates): *

Other skills: *

Briefly explain your plans for the future: *

Provide a detailed account of how you plan to use the knowledge and skills you will gain as a Lactation Educator Counselor (LEC) or a Lactation Consultant: *

Explain how you are suited to providing breastfeeding support to the population that you would serve: *

Explain how you would promote interest in learning about breastfeeding amongst your coworkers or community: *

If you would use your Lactation Educator Counselor or Lactation Consultant knowledge and skills in your current place of employment, please also attach a letter of recommendation from your employer. This letter should address: 1) Why you are a good candidate for this scholarship 2) What opportunities you will have to use the knowledge and skills that you will gain from becoming a Lactation Educator Counselor or a Lactation Consultant and 3) How this fits with your organization’s goals to support breastfeeding. *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of San Diego County Breastfeeding Coalition. Report Abuse

Forms