Apply to attend one of the scheduled trainings

the total cost is 1650 if paid in full
two or three payment options available

payment link will be sent if application is approved

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Name *

First

Last

Email *

Phone Number *

Which session are you applying to attend? City/State *

How long have you been involved in birth work?

What birth/health related websites, publications, podcasts, etc., do you follow?

What is you midwifery education pathway (check all that apply)?

• Self-directed Study
• Attending a Program
• Completed a Program

Practice Status

• Midwife
• Birth Keeper
• Apprentice/Student
• Doula
• Other

If you are a midwife or birth keeper, how long have you been practicing? Please describe your model of care.

If you are an apprentice/student, how long have you been in that role? Please describe your skill level.

If you are a doula, how long have you been practicing? Please describe your experience with home birth.

Do you hold any certifications? Are you working towards obtaining any certifications? If so, which ones?

Are you certified in Neonatal Resuscitation?

have Name professionals,

Do you plan to become licensed to practice in your state?

Please tell us more about your goals.

What is the legal status of midwifery in your state?

Is midwifery/home birth well supported by the greater commnity in your area? for example: supportive transports, allied health professionals, etc.

Do you have relationships and support from other midwives/students/doulas in your area?

Are you a member of your state midwifery organization? If yes, name of organization; if no, why?

Please list workshops and courses you have previously attended.

Enrollment Agreement:

Initial each line to indicate you have read and understand each statement

I understand and agree to the following: *

• Foundational Concepts for Midwives reserves the right to accept or deny any applicant. Referral by the host or an interview with Sarita and/or Rowan may be required prior to approval.
• All funds listed on the website and in the registration page are in US dollars.
• All curriculum materials received are the intellectual property of Foundational Concepts for Midwives and are not allowed to be copied or shared.
• There will be additional expenses not included in the price of the training/retreat, ie: lodging, travel, childcare, dinners
• This training is intended as preparation for, or a compliment to, any midwifery schooling and practical experience under a supervising midwife. Participants will not, under any circumstance, misrepresent themselves as a qualified birth attendant based on enrollment in or completion of this experience alone.
• This training is not refundable. Registration can be transferred to another accepted student or applied to a future training.

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