IBCLC Recertification Fee Scholarship

IBCLC Recertification Fee Scholarship
In efforts to address the needs expressed by IBCLC's of color, Reaching Our Sisters Everywhere Inc. will provide 5 scholarships to assist in covering the $470 USD fee for recertification for the September 30, 2016 deadline. In order to be considered for this scholarship, applicants meet the following requirements:
- Self Identify as a person of Color
- Is currently an IBCLC that NEEDS to recertify by September 30, 2016
- Currently meets ALL the requirements outlined by IBLCE for Recertification by CERPs
- Will commit to participating in a ROSE Train-the-Trainer (at no cost to participant)
- Will commit to participating and/or supporting 4 ROSE initiatives around addressing health equity over a 2 1/2 year period.
- Currently has a PayPal account to accept the funds
- Completes this application by 11:59 pm EST on September 28, 2016.
Scholarship recipients will be notified by 11:00 am EST on September 29, 2016. Due to the quick turn around of this process, only complete application will be considered for this scholarships.
Name*

First NameLast Name
E-mail*
Please provide email associated with your PayPal:*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Please select how you self-identify*

African American/BlackAsian/Pacific IslanderCaucasianHispanic/LatinoMiddle EasternNative American/AlaskanPrefer not to say
Please provide a brief summary of the work you do to support your community.*

0/450
By checking each box, your are agreeing to and confirming the following statements:*

I am currently and IBCLC the NEEDS to recertify by September 30, 2016I currently meet all the requirements outlined by IBCLE to recertify, including but not limited to having AT LEAST 50 L-CERPs, 5 E-CERPs, and 20 CERPs that are either L,E, and/or RI commit to participating in a ROSE Train-the-TrainerI commit to participating in 4 ROSE Initiatives over a 2 and 1/2 year period, from October 1, 2016 - April 1, 2019I commit to providing free lactation support to at least 5 women of color per year until April 1, 2019I commit to providing a report to ROSE on the NUMBER of pregnant and lactating mothers that I have served for every 6 months until April 1, 2019I commit to providing ROSE proof of payment to IBCLE for recertification by 3:00 pm EST on October 4, 2016
Signature: Typing your FULL NAME will serve as your signature on this application. It also certifying that all the information is true and completed to the best of your knowledge.*
Today's date

MonthDayYear
Should be Empty: