Center for the Childbearing Year
Birth Doula Training
Scholarship Application
Please rank the training dates below in order of preference according to
which training you want to take. If you are not granted your first choice
and you have indicated a willingness to attend another training, we will
keep your application active and reconsider you among the next pool of
candidates.
___ February 25-27
___ April 22-24
___ June 24-26
___ August 19-21
___ November 11-13
Name:
Address:
City:
State:
Zip Code:
County:
Phone:
Email:
Check all that apply:
___ Teen mom
___ Single mom
___ Low income
___ Student: type or major _________________________
___ Mother
Racial/ethnic group(s):
___ African-American
___ Arabic
___ Asian
___ Caucasian
___ Hispanic
___ Native American
___ Multi-racial
___ Other (please specify) _________________________
Languages spoken, other than English (please indicate level of fluency):
___ Spanish
___ Arabic
___ American Sign Language
___ Other (please specify) _________________________
Please answer the following questions.
1. Why do you want to be a doula?
2. Have you given birth yourself?
3. Have you had any experience attending births of family members, friends, etc.?
4. Have you ever taken a series of Childbirth Preparation Classes? If so, what method was taught? Where was the class held? How long ago was it?
5. Have you read any books on the subjects of pregnancy, natural childbirth, or breastfeeding? Please
list.
6. How do you expect to manage a lifestyle that involves being "on-call" and rushing off to births on short notice, day or night?
7. Where do you see yourself in 3-5 years?
8. Will you be able to attend every session of the training?
9. Do you intend to fulfill all of the requirements towards Doula Certification? Please visit www.DONA.org for more information on doula certification requirements.
10. The Doulas Care Program is a volunteer program that helps student doulas gain experience at births by matching them with low income, at risk women who could use some extra support during their pregnancy, birth, and postpartum but can't afford to hire a doula. Can you participate as a volunteer doula in the Doulas Care Program through Center for the Childbearing Year for a minimum of 5 women? (Support for one pregnant woman in the community involves providing 3 prenatal visits, attending the birth as labor support, and providing 3
postpartum visits.)
11. Volunteer work must be completed within 18 months of completing the training. If your ability to volunteer as a doula within this timeframe is limited for any reason (i.e., childcare concerns, transportation limitations, current pregnancy, etc., please explain).
12. What is your comfort level or experience in working with a culturally diverse population of women with limited resources?
13. Where or from whom did you hear about this program?
14. How important is this scholarship to you in order for you to become a doula?
15. Is there anything else you would like us to take into consideration when reviewing this application?