2024 Ujima Maternity Network Doula Training Application

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Please complete the questions below.

Email *

Name *

First and last name

Address *

Phone number *

In what County do you reside? *

Relationship Status *

Married

Single

Divorced

Widowed

Required

Number of Children and their (current) age(s) *

Have you ever adopted or fostered children? *

Yes

Other:

Are you bilingual?

Yes

Clear selection

If yes, what language (s) do you speak?

Do you have a birth experience that you would like to share with us? (Traumatic, Beautiful, Home, Hospital, Doula Supported etc.) *

Please list 3 Character References (include Name, Relationship/Career Title, Phone, and email) *

What do you currently understand a birth doula to be? *

What are you most interested in learning or doing as a doula? *

Have you had personal experience with a trained or certified birth or postpartum doula? (Please describe that experience with as much detail as possible) *

Why do you want to become a certified birth or postpartum doula through Ujima Maternity Network, Inc.? (Please keep answers detailed and brief) *

What is your ethnic background? *

Do you have a village or support system for your children when you are called to births? *

Yes

I certify that the information contacted in this application is true and complete. I understand that false information may be grounds for dismissal from the Ujima Maternity Network, Inc. doula training program. I authorize the verification of any and all information listed above. *

Yes

Submit your cover letter or resume (Optional)

A copy of your responses will be emailed to the address you provided.

Submit

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