Advanced Doula Application Please see the Application Packet for Eligibility Criteria, FAQs, and Code of Conduct AdvCD/PCD I am applying for:(Required)Advanced Birth Doula CredentialAdvanced Postpartum Doula CredentialName(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email(Required) Website (Optional) DONA International Membership Expiration Date(Required) MM slash DD slash YYYY 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 Select files Max. file size: 50 MB, Max. files: 3. 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 10 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 p.m. June 30, 2023. I acknowledge that if I fail to submit a complete and legible application, my application may not be accepted My typed signature heron verifies that the informaiton provided in and with thie application is accurate to the best of my knowledgeSignature(Required) Date(Required) MM slash DD slash YYYY 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.
