AdvCD/PCD | DONA International

**Please see the Application Packet for Eligibility Criteria, FAQ’s, and Code of Conduct**

I am applying for:(Required)

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Website (Optional)

DONA International Membership Expiration Date(Required)

Please complete the following applicable birth or postpartum information. Please put N/A for the certification option that does not apply to you.

Birth Doula Certification Identification Number(Required)

Original Birth Doula Certification Date (Month/Year)(Required)

Birth Doula Certification Expiration Date (Month/Year)(Required)

Postpartum Doula Certification Identification Number(Required)

Original Postpartum Doula Certification Date (Month/Year)(Required)

Postpartum Doula Certification Expiration Date (Month/Year)(Required)

Submit Resume/CV, Letter of Intent, and Evidence of Payment(Required)

Drop files here or

Max. file size: 50 MB, Max. files: 3.

My typed signature here verifies that the information provided in and with this application is accurate to the best of my knowledge

Signature(Required)

Date(Required)

Please use the following format to describe how you meet the eligibility criteria. You may upload additional documents, if necessary, but please keep your answers brief (i.e., bullet points, lists, succinct statements, etc.)

List any book(s), journal articles, or industry magazine article(s) online or print (blog posts from your own personal or business website or the personal or business blog of a colleague do not meet this criteria) on the topic of doulas, birth, lactation, parenting or postpartum issues that you authored during your tenure as a DONA certified doula. Include the title, name of the publication, publisher (if any) and date of publication. Include a web address of available.(Required)

File (optional)

Max. file size: 50 MB.

List any presentation(s) of an educational session(s) on the topic of doulas, birth, lactation, parenting or postpartum issues at a national or international conference(s) (not a local event) during your tenure as a DONA certified doula. Include the title and objectives of the session, the name(s) of any co-presenter(s), and the name of the organization, title of the conference, conference date(s) and conference location.(Required)

File (optional)

Max. file size: 50 MB.

List any outstanding achievement(s) you have been awarded and describe why you feel they meet this criterion. Volunteer work or awards should not be included here. Outstanding professional achievements show your desire to excel in your field and take personal initiative to be a leader(Required)

File (optional)

Max. file size: 50 MB.

List the major contribution(s) you made locally, regionally, nationally and/or internationally to advance the mission and purpose of DONA International and/or the recognition of doulas and/or made a significant contribution to, or as a leader in, the perinatal-child field, other than that which promotes or supports your own personal or business endeavors. Include details that will help the committee understand the extent of your contribution(s), including the date(s) and time frame, those who were affected by those contribution(s) and how, and the effect your contributions had on the community(ies):(Required)

File (optional)

Max. file size: 50 MB.

Please use the following checklist to ensure you complete all the steps to complete the application.(Required)

I read the eligibility criteria, included on page 3 of the application packet

I agree to adhere to the Code of Conduct of Advanced Doulas, included on page 7 of the application packet

I've attached my resume or curriculum vitae, highlighting any additional training, certification and/or licensure in a related field(s) during my tenure as a DONA certified doula

I've provided one (1) letter of reference from a person who has worked with me on my contribution(s) in some capacity or who has first-hand knowledge of such

I've paid for the $100.00 non-refundable application fee per application and attached the proof of payment

I completed this application no later than 11:59 pm May 31st. I acknowledge that if I fail to submit a complete and legible application, my application may not be accepted