Application for the I.M.P.A.C.T. Program
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 have evaluated their needs and require financial assistance to cover the costs of a doula workshop, certification costs & fees, and membership fees for one year. Preference will be given to Black, Indigenous, and People of Color (BIPOC), people who are supporting BIPOC and applicants who have a strong desire to “pay it forward” by providing doula services at a low or no cost fee to at least one family in need during the certification process. The family the doula supports must reside in geographic areas where the maternal health disparities and inequities are resulting in a high rate of death of birthing BIPOC at disastrous rates such as: Brooklyn, NY (King’s County), Ft. Worth, TX (Tarrant County) and the entire state of Georgia (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.
Questions? Please email firstname.lastname@example.org
Application Submission Requirements:
1. Provide a statement that includes the following information (written, video or audio formats are acceptable):
A. What is your motivation for seeking to participate in the I.M.P.A.C.T. Program?
B. How do you plan to use the skills learned in the program to benefit your community in the area of maternal mortality?
C. What are your short- and long-term doula-related goals following the completion of the I.M.P.A.C.T. Program?
D. What events or circumstances have shaped your desire to become a doula? List at least three (3) goals.
E. What is your financial hardship? Please describe why you need financial assistance for doula training, certification, and membership.
F. How do you plan to maintain membership with DONA International ($100/year), if accepted to the I.M.P.A.C.T. Program?
G. Please explain or describe how you fall under the Black, Indigenous or Person of Color (BIPOC) umbrella (if applicable).
Reference Submission Requirements:
2. 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:
a. Upload two (2) letters of reference by scanning the document that contains the reference’s signature, email address and phone number AND answer the questions on found on the I.M.P.A.C.T. Reference Check form.
b. Have two (2) references complete the online reference form. Here is the link: I.M.P.A.C.T. Reference Check form