You can always press Enter⏎ to continue
Black Sisters Birth Academy® Online Birth Assistant Program Application Form

Black Sisters Birth Academy® Online Birth Assistant Program Application Form

This application is intended for individuals who are ready to immediately start the certification process to become certified birth assistants. Please fill out the application form carefully to be considered for enrollment. After submitting your application, you will be automatically notified if you qualify to schedule an interview. ​​Only qualified applications will be able to schedule an interview. PLEASE NOTE: Our Online Program is designed for experienced birth workers who are independent learners only. For newcomers to birth work or experienced birth workers looking for in-person training Join Our Waitlist at https://www.blacksistersbirth.com/programs for our Online Program PLUS or Hybrid Program.
  • 1
    A birth assistant (also known as a midwife’s assistant) is a healthcare professional specifically trained to support community midwives with births in out-of-hospital settings, such as homes or free-standing birth centers. A birth assistant can perform several duties under the supervision of a midwife including taking maternal and fetal vital signs, charting, setting up equipment, keeping the birth space clean and organized, providing assistance in obstetrical emergencies and more.
    Press
    Enter
  • 2
    We have a lot of applicants and we want to make sure that the women we invest our time into are committed to taking action as soon as possible. If you are not serious about doing this work now, DO NOT APPLY. 0: being not very important. 5: being extremely important.
    Press
    Enter
  • 3
    1. Must be a Black woman, 18 years old or older, seeking training and certification as a birth assistant. ​ 2. Must have a valid government-issued photo identification (Driver's License, Passport / Card or Permanent Resident Card). ​ 3. Must have proof of a High School diploma, (GED) or higher. ​ 4. Must have proof of a valid CPR Certification through the American Heart Association or American Red Cross or Canadian Red Cross. ​​ 5. Must have proof of a valid NRP Certification through the American Academy of Pediatric or Canadian Paediatric Society. ​​ 6. Must meet the physical requirements: Students are required to have a full range of motion, manual and finger dexterity and eye-hand coordination. Light work is required - Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force constantly to move objects, when it requires walking or standing to a significant degree; or when it requires sitting most of the time.​ 7. Birth Experience/Clinical Background: Must meet ONE of the following criteria: 1.) Experienced Birth Worker:​  This category applies to: Certified birth doulas, Midwifery Portfolio Evaluation Process (PEP) applicants, or birth assistants currently working with a midwifery practice with no formal training or certification. For Certified Birth Doulas:​ - Must submit proof of a valid birth doula or full-spectrum doula certification.​ ​ - Must submit proof of at least three or more out-of-hospital OR hospital birth experiences within the last 12 months.  ​ REQUIRED: ​Three (3) Birth Observation Record Forms must be completed and submitted with your application based on your criteria. ​CLICK HERE TO DOWNLOAD: Birth Observation Record Form. ​ ​ For Midwifery Portfolio Evaluation Process Applicants:​ - Must submit proof of a current Preceptorship Agreement from a NARM Registered Preceptor. ​ - Must submit proof of at least three or more out-of-hospital birth experiences within the last 12 months.  ​ REQUIRED: ​Three (3) Birth Observation Record Forms must be completed and submitted with your application based on your criteria. ​CLICK HERE TO DOWNLOAD: Birth Observation Record Form. ​ ​ For Birth Assistants:​ - Must submit proof of a current employment verification letter as a birth assistant from a midwifery practice or free-standing birth center. ​ - Must submit proof of at least three or more out-of-hospital birth experiences within the last 12 months. ​ ​REQUIRED: ​Three (3) Birth Observation Record Forms must be completed and submitted with your application based on your criteria. ​CLICK HERE TO DOWNLOAD: Birth Observation Record Form. ​ ​ 2.) Healthcare Worker: This category applies to: Registered Nurses (RN), Licensed Practical Nurses (LPN), Certified Nurse Assistants (CNA), Patient Care Assistants (PCA), Patient Care Technicians (PCT) , Certified Medical Assistants (CMA), Physician Assistants (PA).  ​​​ - Must be a healthcare worker with clinical experience in Labor and Delivery or Mother-Baby. ​ - Must submit proof of a valid license or certification as a healthcare worker. ​ - Must submit one (1) professional verification letter from a current or previous employer, supervisor or colleague confirming clinical experience in Labor and Delivery or Mother-Baby.
    Press
    Enter
  • 4
    Applicants applying to Black Sisters Birth Academy®, you must read our Frequently Asked Questions (FAQ) before applying. Our Frequently Asked Questions (FAQ) can be found on our Program Page: https://www.blacksistersbirth.com/programs
    Press
    Enter
  • 5
    PLEASE NOTE: If the selection: None of the above-- applies to you, please leave this application and apply to our online program PLUS or hybrid program at https://www.blacksistersbirth.com/programs.
    Press
    Enter
  • 6
    A verification code will be sent to your email to complete your application. Please check your inbox or spam folder after submitting your email. Ensure you use the same email to schedule your interview if applicable.
    Email Verified
    Email Verified

    The verification code has been sent to some@email.com
    Please check your mailbox and paste the code below to complete verification

    Didn't receive verification code?or
    Receiving the email may take a few minutes, thank you for your patience!
    Press
    Enter
  • 7
    Press
    Enter
  • 8
    -
    Pick a Date
    Press
    Enter
  • 9
    Press
    Enter
  • 10
    Please Select
    • Please Select
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
    Press
    Enter
  • 11
    (Driver's License, Passport / Card or Permanent Resident Card)
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
    Cancelof
    Press
    Enter
  • 12
    (Driver's License, Passport / Card or Permanent Resident Card)
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
    Cancelof
    Press
    Enter
  • 13
    This gives us an idea of the context of the platform you're coming from.
    Press
    Enter
  • 14
    0/300
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 15
    PLEASE NOTE: TO ENSURE ALL DOCUMENTS ARE RECEIVED, PLEASE MERGE THEM INTO ONE FILE BEFORE UPLOADING. FOR EXPERIENCED BIRTH WORKERS: Please submit copies of the following required documents that apply to you: (1.) Certified Birth Doula with at least three out-of-hospital or hospital birth experiences within the last 12 months. REQUIRED: Three (3) Out-of-Hospital Birth Observation Record Forms: CLICK HERE TO DOWNLOAD: Birth Observation Record Form (2.) Midwifery PEP Applicant with at least three or more out-of-hospital birth experiences within the last 12 months.​ REQUIRED: Three (3) Out-of-Hospital Birth Observation Record Forms: CLICK HERE TO DOWNLOAD: Birth Observation Record Form ​​ (3.) Birth Assistant Currently Working with a Midwifery Practice without formal birth assistant education REQUIRED: 1.) An Employment Verification Letter from your midwifery practice or free-standing birth center. 2.) Three (3) Out-of-Hospital Birth Observation Record Forms: CLICK HERE TO DOWNLOAD: Birth Observation Record Form (4.) Healthcare Worker (RN, LPN, CNA, PCT, PCA, CMA, or PA) with Labor and Delivery or Mother-Baby experience. REQUIRED: 1.) Proof of Your Valid Professional License or Certification 2.) One (1) Professional Reference Letter from a current or previous employer, supervisor, or colleague confirming clinical experience in Labor and Delivery or Mother-Baby.
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
    Cancelof
    Press
    Enter
  • 16
    Approved organizations: The American Heart Association or American Red Cross or Canadian Red Cross.
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
    Cancelof
    Press
    Enter
  • 17
    Approved organizations: The American Academy of Pediatric or Canadian Paediatric Society.
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
    Cancelof
    Press
    Enter
  • 18
    Answering this helps us make sure we direct you in the right direction instead of wasting your time providing you a program that wouldn't be a fit.
    Press
    Enter
  • 19
    Press
    Enter
  • 20
    0/300
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 21
    So we can know where you're at to help get you where you want to go and best tailor our program offer to you.
    Press
    Enter
  • 22
    0/300
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 23
    0/300
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 24
    This is so we can get an idea of the midwifery services in your area.
    Press
    Enter
  • 25
    Press
    Enter
  • 26
    Press
    Enter
  • 27
    1 of 4
    Press
    Enter
  • 28
    2 of 4
    Press
    Enter
  • 29
    3 of 4
    Press
    Enter
  • 30
    4 of 4
    Press
    Enter
  • 31
    This is so we can get an idea of your expectations.
    Press
    Enter
  • 32
    Education is an investment. If you qualify for enrollment for our Online Program, an investment of $1,500 USD is required. Payment Plan Options (Online Program): - One Time Payment: $1,500 USD - 5 Installments of $345 USD for 5 months  PLEASE NOTE: If you are accepted into the academy during your interview session, please be prepared to make your tuition payment or initial installation payment at that time. If you are not financially capable of making this investment, DO NOT APPLY.
    Press
    Enter
  • 33
    Press
    Enter
  • 34
    Press
    Enter
  • 35
    I acknowledge that the information given on this application is true and accurate. I acknowledge that I agree to the Application Review Policy of Black Sisters Birth Academy®. I also agree to the terms of services and privacy policy. By submitting this application you agree to the receive email updates and marketing from Black Sisters Birth Academy®.
    Press
    Enter
  • 36
    Press
    Enter
  • Should be Empty:
Question Label
1 of 36See AllGo Back
close