JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Accelerated Certification Registration
Refresher course fee $175
Discounted Certification fee $75
You will have 30 days to complete this course work and 60 days to complete the certification process.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
Mailing Adress
*
Your answer
Email
*
Your answer
Organization that you received doula training.
*
Your answer
When did you complete your training?
*
MM
/
DD
/
YYYY
I am taking the Accelerated Doula Course
*
Because I was trained through Uzazi Village, within the last 5 years and now want to be certified
Because I was trained with Jamaa Birth Village within the last 3 years and now want to be certitfied
Because I am apart of the KCMO Doula Initiative
I certify that I understand that I will have 30 days to complete the course work and 60 days to complete the certification process. If I fail to complete the course work, I understand I will pay the $175 fee again to gain access to the coursework.
*
Yes
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Uzazi Village.
Report Abuse
Forms
