Georgia IBCLC Spring Exam Scholarship Application

Northwest Georgia Breastfeeding Coalition Scholarship Application For International Board-Certified Lactation Consultant Exam
The Northwest Georgia Breastfeeding Coalition (NWGABFC) serves to protect and support breastfeeding as the preferred and accepted method of infant feeding. Our activities focus on education and training, data collection, and the dissemination of current research information as well as community and public health advocacy.   In support of the NWGABFC’s mission, we are excited to announce the expansion of the Carol and Jay Srymanske Scholarship program.
NWGABFC has offered scholarships to students and breastfeeding professionals to attend the Annual Northwest Georgia Breastfeeding Conference for 20 years. This year, NWGABFC is expanding the Carol and Jay Srymanske Scholarship program to include examination fees for the IBCLC exam.
As funds are available, scholarships are awarded for the initial examination, recertification by examination, and recertification by CERP’s. Scholarship applicants must reside or serve families in Whitfield, Murray, Fannin, Pickens, Gilmer or Cherokee Counties in Georgia.
To apply for scholarship consideration, please complete the following application.   All Applicants must be eligible for examination/recertification at the time of application.
The number of scholarships awarded are based on available funding.

Personal Information:
1.         Scholarship applicants must reside or serve families in Whitfield, Murray, Fannin, Pickens, Gilmer, or Cherokee Counties in Georgia.
2.         Scholarships are awarded for Initial Examination, Recertification by Examination, and Recertification by CERPs.
3.         Expectation of employment or volunteer in lactation related area.
Applicant's Name*

First NameLast Name
Mobile Number*
Please enter a valid phone number.
Email*
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Lactation Employment Information: (please list all lactation experience paid or volunteer)
Place of employment:
What percentage of your work time do you spend working with breastfeeding families?
Describe jobs duties:
Place of employment:
What percentage of your work time do you spend working with breastfeeding families?
Describe jobs duties:

Professional Memberships & Community Based Volunteer Organizations
Please List Professional Memberships:
Please List Community Based volunteer organizations you are a member or volunteer:

Northwest Georgia Breastfeeding Coalition Scholarship Application For International Board-Certified Lactation Consultant Exam