Interior Hero

Application for the I.M.P.A.C.T. Program 

Here is the link to the program basic information and references:

Thank you for your interest in the I.M.P.A.C.T. Program. To apply, please complete the application below.

The I.M.P.A.C.T. Program is for people who want to be doulas, but face barriers and need financial assistance to cover the costs of a doula workshop, certification costs & fees, and membership fees for one year. This program is for Black, Indigenous, People of Color (BIPOC), Asian, Hispanic/Latine or first generation immigrant applicants who reside in geographic areas where the perinatal health disparities and inequities are resulting in a high rate of death of birthing and postpartum people of color at disastrous rates such as: King’s County (New York), Tarrant County (Texas), the entire state of Georgia (U.S.) and southern states within the U.S.

In this application, we request an explanation of your personal circumstances and a description of any financial limitations. We also seek information about you and your goals.

Do you have questions? Email your questions to

Application Submission Requirements:
Provide a statement that includes the following information (written, video or audio formats are acceptable):

1. What is your motivation for seeking to participate in the I.M.P.A.C.T. Program?
2. How do you plan to use the skills learned in the program to benefit your community in the area of perinatal mortality?
3. What are your short- and long-term doula-related goals following the completion of the I.M.P.A.C.T. Program?
4. What events or circumstances have shaped your desire to become a doula?  List at least three (3) goals.
5. What is your financial hardship? Please describe why you need financial assistance for doula training, certification, and membership.
6. How do you plan to maintain membership with DONA International ($100/year), if accepted to the I.M.P.A.C.T. Program?
7. Please explain or describe how you fall under the Black, Indigenous or Person of Color (BIPOC), Asian, Hispanic, or first generation immigrant umbrella.

Reference Submission Requirements:

Provide references.  References can be completed by work or educational supervisors, employers, birth workers, colleagues or

professionals in the birth, postpartum or community doula field answer the questions

on the I.M.P.A.C.T. Reference Check form.  You can submit your references in one of two ways:

#1. Upload two (2) letters of reference by scanning the document that contains the

reference’s signature, email address & phone number AND

answer the questions found on the I.M.P.A.C.T. Reference Check form.


#2. Have two (2) references complete the online reference form.

Here is the link: I.M.P.A.C.T. Reference Check form