APPLICANTS MUST READ AND ACCEPT
*
- Applicants will be considered by a review board consisting of members of Birth in Color RVA
- Previous birth experience is helpful, though not required
- A select number of applicants will move onto a virtual interview
Applicants accepted into the The Birth in Color RVA Project agree to:
- Attend a three-day doula training
- Attend an induction ceremony - Date TBD
- Complete 10 hours of self-guided study, client communication, and skills work a week
- Provide culturally competent care to 8-10 pregnant clients including: 4 prenatal visits, 4 postpartum visits, continuous labor support, record keeping, and phone support
Name
*
First Name
Last Name
Preferred Pronouns
*
she/her
he/him
they/them
other
Race
*
Black
Hispanic / Latinx
Asian
Indigenous
Multi-Racial
White
Description of Race
*
Date of Birth
*
MM
DD
YYYY
Email
*
Phone Number
*
(###)
###
####
Physical Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Mailing Address
If different from physical address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Annual Household Income
$0 - $12,000
$12,001 - $16,000
$16,001 - $22,000
$22,001 - $36,000
$36,001 - $58,000
$58,001 +
Do you have children?
*
Yes
No
If so, list their ages.
*
Are you currently pregnant or do you plan to get pregnant in the next 12 months?
*
Yes
No
Are you a certified doula?
*
Yes
No
Have you attended births?
*
Yes
No
Have you taken other birth worker trainings?
*
Yes
No
If yes, please list courses.
*
Character Reference 1
*
If applicable
First Name
Last Name
Character Reference 1 Phone Number
*
(###)
###
####
Character Reference 2
*
First Name
Last Name
Character Reference 2 Phone Number
*
(###)
###
####
Personal Story
*
Use the area below share your "why." What led you to apply for this program? What do you feel you could contribute personally to Women of Color in our community.
Other
Use this area to add anything else you would like to share with the review board.
By checking this box, I acknowledge that Doulas are often required to attend births for substantial lengths of time. I confirm that I am in good physical health, I have family and/or friends willing to support me, and I am aware of the importance of self-care.
*
Thank you for submitting an application to become a community-based doula. Please be patient and do not re-submit your application, if you are reading this message, your application has been received.
We process applications based on the next upcoming training. You should hear back from us 6-8 weeks before the training date to schedule a followup interview , in which you will receive information regarding the doula training.
Please note that, after your training, you will begin part-time birth work almost immediately and that access to reliable transportation is a requirement. Complete client care includes 4 prenatal visits, labor and birth support, 4 postpartum visits, and phone/text support for your clients. This application is to train with and become a part of the Birth in Color Doula collective in your area.
If you have any questions please email: hello@birthincolorrva.org
