Peer Lactation Counselor Application

We Need Peer Lactation Counselors!

Calming Nature Doula Service & Center, Buffalo's Breastfeeding Sister African American Breastfeeding Group.
Who we are:

Buffalo's Breastfeeding Sisters, is our Breastfeeding support program for African American women in the city of Buffalo. In collaboration with Reach Buffalo, Racial and Ethnic Approaches to Community Health Program, funded through the CDC's Division of Nutrition, Physical Activity, and Obesity’s (DNPAO) initiative to help reduce health disparities among racial and ethnic populations with the highest risk. Our goal is to help promote and increase the number of African American women breastfeeding.

The program is here to aid and promote the normalcy of breastfeeding in the African American community.
Here we provide African American women with a safe space to feel comfortable and welcome to discuss their concerns and questions. We debunk debunked and provide evidenced based information. Our goal is to educate families to have a better understanding of breastfeeding, the importance, and its benefits.
Qualifications:

Must have breastfeed for at least 6 months within the last 5 years.
Must identify as an African American.
Have an flexible availability for phone and/or virtual support to families.
Must also agree to attend weekly breastfeeding group classes
Written essay on why you like to be a Peer Lactation Counselor (PLC).
Must speak to your experience with breastfeeding
Mentoring experience preferred, but not required
Experience with other factors around maternal health, facilitating, and/or of civic groups
Attend a PLC training and complete all modules of the training.
Own a cell phone.
Have an active email address.
Have a minimum of 10 contacts per client on a monthly basis.
Agree to meet monthly with a peer supervisor to discuss outcomes and experiences.
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Day Time Phone*

Area CodePhone Number
If you were referred by an employee of Calming Nature or Buffalo's Breastfeeding Sisters, please list their name below.

First NameLast Name
Do you have reliable transportation?*

YesNo
Do you have reliable internet access?*

YesNo
Do you identify as African American?*

YesNo
Are you able to dedicate to a minimum of 10 hours per month?*

YesNo
Are you able to dedicate to attending one evening group class per month?*

YesNo
What Days Are You available to work?*

WeekdaysWeekends
WORK HISTORY / EXPERIENCE

Please list your 2 most current work history/experience.
Employer's Name (Most current)*
Position Held*
Supervisor's Name*
Telephone*

Area CodePhone Number
What are you duties?
Reason for Departure
Start Date*

MonthDayYear
End Date*

MonthDayYear
(2) Employer's Name
Position Held
Supervisor's Name*
Telephone

Area CodePhone Number
What are your duties?
Reason for Departure
Start Date

MonthDayYear
End Date

MonthDayYear
Your Breastfeeding Experience:

Please list your breastfeeding experience below. Also please attach your written statement on why you would like to be a peer counselor.
Please upload a copy of your written statement as to why you'd like to become a PLC.*
How long did you breastfeed?*

0-6 months6-12 months.More than 12 months
How long has it been since you stopped breastfeeding?*

Less than 1 year1-3 years?3-5 years?More than 5 years?
Did you experience any challenges during your breastfeeding journey? If, so explain how you overcame this challenge. *
Please provide 3 references.

Professional references only.
Reference (1) Name*
Reference (1) Telephone*

Area CodePhone Number
Company*
Reference (2) Name*
Reference (2) Telephone*

Area CodePhone Number
Company*
Reference (3) Name*
Reference (3) Telephone*

Area CodePhone Number
Company*
Do you have experience in mentoring and working in the community? If so please list it below.
Availability:
Are you available for interviews on one or more the following dates and times?*

Friday August 18th between 10am-1pm?Monday August 21st between 10am-4pmFriday August 25th between 10am-4pm?Thursday August 17th between 1pm-4pm?
Enter the message as it's shown*
Type a question
Should be Empty:

We Need Peer Lactation Counselors!

WORK HISTORY / EXPERIENCE

Your Breastfeeding Experience:

Please provide 3 references.

Availability: