ICEA 2021 Scholarship Form

Which ICEA certifications do you hold now or have held in the past?
Indicate below any other relevant certifications you hold from another organization. Please include organization name and approximate date of certification.
ICEA has adopted the Core Values of Compassion, Collaboration, and Choice. In your words describe what these values mean to you and your role as a birth professional. *
Please list any birth-related work and/or volunteer experience:
How could your ICEA certification benefit your community? *
There are many volunteer positions within ICEA which allow for professional development (examples: blog writers, conference presenters, committee members,etc.). As a scholarship recipient, how would you give back to ICEA? *
What is your primary language? This helps ICEA to reach out to additional resources if this application is not in English. *
Do you give ICEA permission to publish your name (newsletter, website and social media) and a picture upon receipt of a scholarship? Please select one: *

Yes No
Additional Documentation: Please submit contact information for two (2) professional or personal references below:
Reference 1 Name *

First Name Last Name
Reference 1 Email *
example@example.com
Reference 1 Phone Number

Country Code Area Code Phone Number
Reference 2 Name *

First Name Last Name
Reference 2 Email *
example@example.com
Reference 2 Phone Number

Country Code Area Code Phone Number
ICEA offers a mentorship program. Upon receipt of a scholarship, the scholarship committee will pair you up with a mentor. ICEA will introduce you to each other and then you can use that contact to help you with your ICEA journey.

Upon receipt of your submission and required documents, your application will be reviewed by the Scholarship Committee and a decision will be made within 30 days.

Please be sure to print a copy of your completed applicatonf for your records prior to clicking Submit.
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