BIRTH IN COLOR LYH APPLICATION

Black, Brown, or Indigenous Women should complete the form below prior to be considered for future Doula trainings.

Applications will be considered by a review board consisting of members of both Birth in Color and The Motherhood Collective/HumanKind.
Previous birth experience is helpful, though not required.
A select number of applicants will move onto an in-person or virtual interview.

Applicants should be aware that they are applying for a program which will prepare them to be placed immediately into birth work. Birth work consists of long hours and can be mentally and physically taxing. Individuals who are not comfortable working inside a hospital or have compromising health conditions should not apply.

Name

First Name

Last Name

Race

Funding for this project is available to Black, Brown, and Indigenous Women only.

Date of Birth

MM

DD

YYYY

Email

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have children?

Yes

No

If so, please list their ages.

Are you a Certified Doula?

Yes

No

If yes, please list certifying body.

Have you attended births?

Yes

No

If yes, in what capacity?

Please list all experience. Friend, midwife assistant, birth support, etc.

Have you taken other birth worker trainings?

Yes

No

If yes, please list courses.

Character Reference 1

First Name

Last Name

Character Reference 1 Phone Number

(###)

###

####

Character Reference 2

First Name

Last Name

Character Reference 2 Phone Number

(###)

###

####

Personal Story

Use the area below share your "why." What led you to apply for this program? What do you feel you could contribute personally to Women of Color in our community.

Other

Use this area to add anything else you would like to share with the review board.

By checking this box, I acknowledge that Doulas are often required to attend births for substantial lengths of time. I confirm that I am in good physical health, I have family and/or friends willing to support me, and I am aware of the importance of self-care.