Name

First Name

Last Name

Number

We are currently only accepting applications from those living and working on Vancouver Island

Please tell us which community on Vancouver Island you will serve

Please tell us about why you are interested in attending this training and how you hope to share what you learn with your communities.

If applicable, please describe any experience you have doing reproductive health/justice work, or work with people during or after their birth.

Do you have access needs that we should know about to support your participation at the training?

Please list the language(s) you will be providing your doula services in.

Please confirm that you identify as BIPOC. Select all that apply.

Black

Indigenous

Mixed-race

Person of colour

Would you like to share anything about your cultural background and/or ancestry? (Optional)

We are a grassroots, mutual-aid initiative. Our community invests in the resurgence of birth work which enables us to offer our trainings at no-cost. We encourage all trainees to pay-it-forward if you are able by making a contribution to the Birth Resurgence Fund.

Pay-it-forward contribution (the true cost per participant is $500)

I understand that I must attend all sessions in order to receive certification as a Postpartum Doula.

Yes

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