Summer Solstice Revival Application 
Please fill out the entire application to the best of your knowledge to determine eligibility to establish a working relationship with Beehive Birth Consulting through our 3-Day Summer Solstice Revival Birth Worker Training.
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Email *
Date of Birth *
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Full Name *
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 at least 4 hours per day to this training? *
Do you have access to the internet and a loptop or other device to access class? *
Are you able to begin the June 21st, 2024 class which ends June 23rd, 2024? *
Do you plan to attend live births after completing this training? *
Do you have prior birth worker experience? *
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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Are you able to invest a minimum of $369 in your education? Returning students $279 (Please note that THIS IS A PROMOTIONAL PRICE IN OBSERVATION OF OUR BLACK HERSTORY 366 INITATIVE.  (To make this course accessible for all, we expect full payment in the amount of $369. We are offering (3) scholarships on a sliding scale for those in economic hardship for $100) *
Are you interested in pursuing additional  mentorship, apprenticeship, or 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
What are your goals for participating in this training? *
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