Wisconsin Guild of Midwives
Scholarship Application
Please complete this form in its entirety, incomplete applications will not be considered.
Please include your statement of intent as well as well as up loading your two letters of reference. Applicants must be a current member of the Wisconsin Guild of Midwives. Application deadline is the second Friday of May. you have questions regarding this application please email the committee at wiguildscholarships@gmail.com
Name Please Indicate name that would be on the potential award check
First Name
Last Name
Preferred Name
First Name
Last Name
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Are you currently a member of Wisconsin Guild of Midwives?
Yes
No, (Applicants must be current members of the Wisconsin Guild of Midwives for their application to be considered.)
If you are a student are you currently enrolled in a school program or the North American Registry of Midwives Portfolio Evaluation Process (NARM PEP)
Yes
No
I am a midwife pursuing another type of education opportunity
Please provide the WGOM a statement of intent describing the intended specific use of this scholarship. Answer these questions; How will you use these funds? What are your goals in your midwifery education or your practice? What impact will this funding have on your community or the populations you serve? {Please response in 1-3 short paragraph (around 150-300 words) We are not looking for polished just honest responses}
Please briefly describe your current educational path or professional development related to midwifery (program, apprenticeship, certifications, etc.)
Please provide your 1st letter of recommendation. Please save your document as follows: yourfirst.lastname.1reco ( ie sally.smithe.1reco) {Please response in 1-3 short paragraph (around 150-300 words) We are not looking for polished just honest responses}
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Please provide your 2nd letter of recommendation. Please save your document as follows: yourfirst.lastname.2reco ( ie sally.smithe.2reco) {Please response in 1-3 short paragraph (around 150-300 words) We are not looking for polished just honest responses}
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Which of the following apply to you? Check all that apply
Person of Color
I serve underserved communities
I am part of or serve a culturally distinct/plainclothes community
LGBTQI+
Prefer not to answer
Optional Demographic Questions
The following questions are optional and are used only to support equitable distribution of scholarship funds. Your responses will remain confidential and will not impact eligibility.
Gender Identity
Race/Ethnicity
Communities Served Check all that Apply
Rural
Low Income or Uninsured Populations
Immigrant or Refugee Communities
LGBTQIA+
Plainclothes or culturally distinct communities
Other
Primary Area of Practice or intended service: County or Region
Are you a first generation college or professional student?
Yes
No
Unsure
By signing below I certify that the statements herein are true to the best of my knowledge and grant my permission for the information contained herein to be shared the scholarship committee(s) and scholarship donor(s)
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