Apply – The Midwifery Institute

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Midwifery Diploma Application

The Midwifery Institute’s Midwifery education program is a comprehensive and rigorous education program in the field of midwifery. Our admissions policies can be found (Here)

Preferred Name

Prefix

Legal First Name *

Legal Last Name *

Date of Birth *

Phone *

Email Address *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Pronouns *

If Other, Please Provide

Have you earned a High School Diploma or GED? *YesNo

High School Diploma or GED

No file chosen

Please upload your high school diploma, Transcripts or GED here

Have you completed a Doula certification Course? *YesNo

If yes, which Certification?

Doula Certification

No file chosen

Please upload your Doula Certification/Certification or proof of completion here.

Have you Attended a College Level English Course? *YesNo

Have you attended a college level Statistics Course? *YesNo

College Transcript

No file chosen

If Applicable, please upload college transcripts showing required courses.

Preferred Session Start Date *

Fall 2023Winter 2024Summer 2024

Preferred Student Status *

Full Time- Year Round (3 Sessions per calendar year)Full Time- School Year (2 Sessions per Calendar year)Part Time (fewer than 12 courses per calendar year)

How many births have you previously attended, not including your own? *

Have you located a preceptor? *YesNo

If yes, Preceptor's Name

If yes, Preceptor's Location

Where do you intend to complete your apprenticeship? *

Why do you want to become a Midwife? *

How do you intend to complete your community service requirement? *

Personal Essay Upload

No file chosen

Please see "How to Apply" for essay requirements. applications without an appropriate personal essay will be automatically rejected.

Are you able to afford our Midwifery Education Program without a scholarship? *YesNo

Will you be applying for our scholarship Program? *YesNo

Demographics

This section is optional. The Midwifery Institute is an equal opportunity employer and educational institution. There shall be no discrimination against any employee, applicant for employment or any student on any basis including actual or perceived sex, gender identity, race, color, marital status, ethnic origin, religion, age, sexual orientation, or disability. This non-discrimination policy applies to all educational policies and programs and to all terms and conditions of employment, which include (but are not limited to): recruitment, hiring, training, compensation, benefits, promotions, disciplinary actions and termination.

Race *

Do you Identify as LGBTQIA+? *

Do you use a language other than English at home? *YesNoChoose not to answer

If yes, What Language?

Do you have a disability or learning difference for which you would like to apply for educational accommodation? *YesNo

If yes, Please explain.

Consent & Submission

Consent *

Yes, I agree with the Application policy and have read and understood all information provided on the Midwifery Education Program

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