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Black Sisters Birth Academy® Online Birth Assistant Program Application Form

Black Sisters Birth Academy® Online Birth Assistant Program Application Form

Black Sisters Birth Academy® provides experienced Black birthworkers—birth doulas, student midwives, birth assistants, and clinical staff—with the comprehensive clinical training necessary to work confidently alongside community midwives in out-of-hospital settings as certified birth assistants. This application is for individuals ready to immediately start the certification process. Please fill out the application form completely to be considered for enrollment. Upon submission, your application will be reviewed within 24 to 48 hours. An official enrollment decision will be sent directly to your submitted email address. ​​No interview is required. 
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    (Driver's License, Passport / Card or Permanent Resident Card)
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    PLEASE NOTE: TO ENSURE ALL DOCUMENTATION IS PROCESSED, PLEASE MERGE ALL REQUIRED PAGES INTO A SINGLE FILE BEFORE UPLOADINGTHEM INTO ONE FILE BEFORE UPLOADING. (1.) FOR COMMUNITY-BASED BIRTH DOULAS: REQUIRED: 1.) Must submit proof of a valid birth or full-spectrum doula certification.​ ​2.) Must provide a professional website/social media link or a midwife reference. ​3.) Must provide documented proof of 3 out-of-hospital birth experiences (home birth or freestanding birth center) within the last 24 months. [CLICK HERE TO DOWNLOAD: Birth Observation Record Form] (IF NEEDED FOR FORMAL DOCUMENTATION) ​​ (2.) FOR STUDENT MIDWIVES: REQUIRED: 1.) Must provide proof of an active NARM PEP preceptor-student agreement or official midwifery school verification, under active midwifery preceptor supervision OR Documented proof of 3 out-of-hospital birth experiences (home birth or freestanding birth center) within the last 24 months. [CLICK HERE TO DOWNLOAD: Birth Observation Record Form] (IF NEEDED FOR FORMAL DOCUMENTATION) ​​ (3.) FOR PRACTICING BIRTH ASSISTANTS: REQUIRED: 1.) Must provide a current employment verification letter from a midwifery practice or freestanding birth center OR Documented proof of 3 out-of-hospital birth experiences (home birth or freestanding birth center) within the last 24 months. [CLICK HERE TO DOWNLOAD: Birth Observation Record Form] (IF NEEDED FOR FORMAL DOCUMENTATION) (4.)FOR HEALTHCARE PROFESSIONALS (RN, LPN, PA, CNA, PCT, PCA, CMA): ​REQUIRED: 1.) Must provide proof of a valid clinical license (RN, LPN, PA) or state-recognized certification (CNA, PCT, PCA, CMA).​​​​​ 2.) Must provide a professional verification letter from a current or previous colleague or employer confirming your clinincal experience on a Labor & Delivery or Mother-Baby unit, OR Documented proof of 3 out-of-hospital birth experiences (home birth or freestanding birth center) within the last 24 months. [CLICK HERE TO DOWNLOAD: Birth Observation Record Form] (IF NEEDED FOR FORMAL DOCUMENTATION) MANDATORY REQUIREMENT FOR HEALTHCARE PROFESSIONALS SEEKING THE ONLINE PATHWAY: 3.) All Online applicants must provide a signed Midwife Attestation Letter prior to applying, confirming an agreement from a licensed, certified, or traditional midwife within their respective jurisdiction to supervise their Phase Two clinical requirements. Note: If you do not have this written agreement secured before applying, you must apply via the Hybrid Pathway.​ [CLICK HERE TO DOWNLOAD: Our Midwife Attestation & Clinical Intent Form PDF]
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    I acknowledge that all information provided on this application is true and accurate. I agree to the Application Review Policy of Black Sisters Birth Academy®, alongside our terms of services and privacy policy. By submitting this application, I agree to receive official academy updates and coomunity notification from Black Sisters Birth Academy®.
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