Application for Midwifery Student Scholarship Fund

Use the space provided to describe your goals and ambitions for your midwifery practice:*

Where do you plan to practice midwifery? (City & State)

Where do you plan to practice midwifery?

Birth CenterHomeBoth

Do you plan to accept Medi-Cal/Medicaid for your midwifery services?

YesNoUndecided

Please use the space below to describe how your future midwifery practice aligns with HMHBA’s mission:*

https://motherbabysupport.net/vision-mission/

Once licensed, would you be interested in working with HMHBA?*

YesNoMaybe

What do you intend to use the funds for? Please describe. Be as detailed as possible with exact amounts needed and for what purpose (tuition, books, licensing fees are allowable expenses):*

Midwife Name

Midwife Email

example@example.com

Client Name

Client Email

example@example.com

Please attach Midwife Preceptor and client letters of recommendation:

Please submit a 5–7 minute video (using Zoom or your phone) introduction along with your application, describing:

1. Your First and Last Name
2. City and State where you live and/or work currently
3. Why did you decide to become a midwife?
4. The intended population you plan to serve
5. Any languages you speak/read/write fluently
6. Where do you plan to set up your practice?
7. Will you be doing Birth Center or Homebirths or Both?
8. The Midwifery School you attend(ed)
9. Your Midwife Preceptor’s Names and Locations
10. Whether you are a CPM (new graduate)
11. Anticipated or Actual Graduation Date
12. How many births have you attended as a student midwife, and in what capacity? (observer, assistant, primary under supervision, and gynecology).
13. Your goals and ambitions for your midwifery practice
14. Describe how your mission aligns with HMHBA’s mission
15. Describe your current financial situation and why you are need of a scholarship
16. How you intend to use the funds
17. When you plan to take the licensing exam and where
18. Anything else you want us to know about you

Video Upload

Or Video Link

Application for Midwifery Student Scholarship Fund

List your Midwifery Preceptors

Please list a Midwife Preceptor and a client for whom you were the Primary Midwife under Supervision or Assistant Midwife.