Safe and Sacred Doula Training Application

Safe and Sacred Doula Training Application

Please complete the application using the information requested in the PDF. All fields are optional unless marked required. Upload a valid government-issued photo ID and review the acknowledgment statements before submitting.
Applicant Information
Legal first name

First NameLast Name
Preferred name
Pronouns
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Are you at least 18 years old?
Email address
example@example.com
Mobile phone number
Please enter a valid phone number.Format: (000) 000-0000.
Street address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City
State and ZIP code
Emergency Contact
Emergency Contact Name

First NameLast Name
Relationship
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Background and Experience
Current employment status
Highest education completed
Why do you want to become a doula?
What experiences, strengths, or values would you bring to birthwork?
Which mothers, families, or communities are you most interested in serving?
Do you have experience in maternal health, healthcare, social services, or community support?
If yes, briefly describe your experience.
Do you currently hold doula training or certification?
If applicable, list the organization and credential
Do you currently hold State of Ohio Certified Doula status through the Ohio Board of Nursing?
List other relevant credentials, licenses, or certifications
Training Commitment and Access
Can you attend all eight Saturday sessions from 12:00–5:00 PM?
If you anticipate a conflict, please explain it here.
Do you have reliable transportation to the in-person Toledo training location?
List any accessibility accommodations you would like us to discuss.
Which professional pathways interest you?
What experience do you have with insurance, Medicaid, or managed care organizations?
What do you hope to accomplish during the six-month mentorship period?
Why should you be selected for this limited 15-person cohort?
Tuition and Referral
Tuition planning
How did you hear about the academy?

Other
Uploads, Agreements, and Submission
Valid government-issued photo ID

Cancelof
Required acknowledgments
May we contact you by email and text regarding this application and academy updates?
Photo/media permission for academy activities
Typed legal signature

First NameLast Name
Submission date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty:

Safe and Sacred Doula Training Application

Applicant Information

Emergency Contact

Background and Experience

Training Commitment and Access

Tuition and Referral

Uploads, Agreements, and Submission