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Syracuse Community Doula Training
Date & Location TBD
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First and Last name
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Address
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Phone
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Email
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Race/ Ethnicity
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Date of Birth
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How did you hear about the Syracuse Community Doula Training?
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Why are you interested in becoming a doula?
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Please share any activities, groups, volunteer or community work you participate in.
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Describe an experience where you supported someone who was going through a difficult time.
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Please list a Personal Reference (Name, Relationship, Phone number, Email, Years Acquainted)
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Please list a Professional Reference (Name, Relationship, Phone Number, Email, and Years Acquainted)
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If I receive this scholarship, I will make every effort to attend the full 3-day Doula training, and I understand that there are additional requirements to receive Doula Certification over the course of 9 months. I agree to provide doula services for at least 3 Syracuse Healthy Start clients as part of the program.
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