Basic Arise BIPOC Midwife Application

IN RESPONSE TO FEEDBACK, PLEASE USE THIS CONDENSED APPLICATION TO INDICATE YOUR INTENT TO PARTICIPATE IN THE ARISE BIPOC MIDWIFE FUTURE OF MIDWIFERY CELEBRATION

Please provide basic details. You will have more time to finish the full application after we have confirmed the Fall 2026 Arise BIPOC Midwife Cohort. Remember this Fall, we are honoring Black, Indigenous, and People of Color (BIPOC) as an extension of Arise Black Midwife!
Full Name

First NameLast Name
I am participating as a/an
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address for your Intake Package

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Current Educational Institution or N/A
Genre of Midwifery (Traditional, CPM, CM, CNM)
This event on October 17, 2026 2-6pm will be hybrid, and both virtual and in-person participants will enjoy the same benefits. Will you be participating in the Pinning Ceremony in person or virtually?
Honorees will be required to participate in preparation activities the day before the affair on Friday, October 16th, 5-8 pm. Are you available to participate?
What size shirt do you wear?
In-person attendees can invite up to 2 family/friends. How many family/friend tickets do you plan to use? If you have more than 2 guests, you can invite them to make a suggested donation of $25 in your honor.
"ARISE Community" is an opportunity for your village to support you by giving a tax-deductible donation in your honor using the Pledge platform: https://www.pledge.to/arise-bipoc-midwife . Some may choose to donate to be present (a suggested donation of $25), and others may choose to be a Sponsor. Donations that go above the suggested amount will be remitted to support the Honoree as a midwifery fund. Please let us know if you would like to participate in the ARISE Community effort and share feedback on whether this could be an effective way to support you. Participation is voluntary.
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IN RESPONSE TO FEEDBACK, PLEASE USE THIS CONDENSED APPLICATION TO INDICATE YOUR INTENT TO PARTICIPATE IN THE ARISE BIPOC MIDWIFE FUTURE OF MIDWIFERY CELEBRATION