Scholarship Application

Our Scholarship Program and application will be available soon.

Scholarships are awarded based ONLY on the information provided on this form. 15 Scholarships are available for each cohort, ranging from 25-100% of tuition and fees. Books and supplies remain the responsibility of the student.

SCHOLARSHIP APPLICATIONS SUBMITTED WITHOUT AN ADMISSIONS APPLICATION WITHIN 7 DAYS WILL BE REJECTED.

Prefix

Legal First Name *

Middle Name

Last Name *

Phone *

Email Address *

Have you already submitted an Application to our Midwifery Program? *YesNo (If no, Please STOP and do not submit this application until you have)

in at least 2 sentences, Why are you applying for our Midwifery Diploma Scholarship program? *

Have you previously completed a Doula education program? *YesNo

Do you Identify as a member of a protected minority group? *YesNoThis includes disability, race, ethnic group, religion, sexual orientation, gender identity, veteran status.

If yes, Please self-Identify *

Proof of Income *

No file chosen

Please provide a paystub, explanation of benefits or recent tax document demonstrating income

In a Minimum of 250 words, please explain how you will use your midwifery education to improve the lives of your clients. *250 words is approximately 1 page. Applications that do not meet this minimum requirement will be rejected.

Reference # 1 Name

Reference # 1 Phone

Reference # 2 Name

Reference # 2- Phone

Consent *

I Understand that the information I have provided will be used to determine my eligibility for a scholarship ranging from 0-50% of the cost of tuition and fees, including needs based, achievement and identity based scholarships provided by the Midwifery Institute to it's students.

Consent *

I Understand that failure to provide all of the information requested will result in my application for scholarship funds being denied, regardless of my actual qualifications for scholarships, as the above information is the only information that will be used to determine my eligibility.

Consent *

The above information is accurate under penalty of dismissal from all Midwifery Institute programs and civil suit for the balance of any aid I am awarded.

Sign *0 / 40