InTune Mother Perinatal Wellness Consultant Application
Please fill out the entire application to the best of your knowledge to determine eligibility to establish a working relationship with The InTune Mother Society through our federally recognized apprenticeship program.
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Name (First and Last) *
Phone Number *
Email *
Birth Date *
MM
/
DD
/
YYYY
Street Address *
City *
State *
Zip Code *
Are you currently employed? *
If currently employed, please list your occupation *
Education Level *
Total Houselhold Income *
Do you have children? *
What is your availability to work with clients after training? *
Do you have the ability to be on a scheduled rotation to attend births and provide postpartum care? *
Are you able to attend a minimum of 2 births per month? *
Do you have prior birth experience? *
Do you have home visitation and/or case management experience? *
Are you a currently trained birth worker? (Check all that apply) *
Are you able to invest a minimum of $3250 in your education? *
Which program are you most interested in to pursue your education? *
If applicable, please list any other health-related trainings, degrees, licenses, or certifications and dates completed
What are your goals for becoming a Perinatal Wellness Consultant? *
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