Pathways Program Open Enrollment Application
Please fill out the entire application to the best of your knowledge to determine eligibility to establish enrollment in The InTune Mother Society ~ School of Perinatal Health through our 12-Month Pathways Program. Space is limited so, upon completion of this application you will be notified to sechedule an interview if you meet the qualifications to proceed with the program. Best wishes to you and thank you for applying.
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Email *
Today's Date *
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Date of Birth *
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Full Name *
Phone Number *
Address (Please include City, State, and Zip code)
Are you currently employed or enrolled in another program? *
If currently employed or enrolled, please list your occupation or institution *
Education Level *
Total Houselhold Income *
Do you have children? *
Are you available to commit 2144 hours to this training? *
Are you prepared to invest a minimum of $7950 in this training? (Tuition assistance is available for those who qualify) *
Do you believe you qualify for tuition assistance? (i.e., SNAP benefits, TANF, Section-8) *
Do you have access to the internet and a loptop or other device to access class? *
Which training cohort are you interested in? *
Do you have access to a computer, laptop, or mobile device and stable internet to complete this training? *
Do you plan to attend live births after completing this training? *
Do you have prior experience working with childbearing families? *
Are you a currently trained birth worker? (Check all that apply) *
Have you ever taken this training before? *
If yes, when?
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Do you have an up to date US Passport? *
Are you interested in pursuing additional mentorship or advanced education? Choose all that apply to your educational goals. *
Required
If you marked that you are you interested in pursuing advanced education--Choose all that apply to your educational goals. *
Required
If applicable, please list any other health-related trainings, degrees, licenses, or certifications and dates completed. If none, please mark N/A *
What are your goals for participating in this training? *
Any additional questions are concerns please submit those here.
A copy of your responses will be emailed to the address you provided.
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