Birth Culture Doula Apprenticeship Training Registration

Welcome Future Doula!

We're so excited that you're interested in joining our community! This program is designed to help you grow your skills, discover your strengths, and make a real difference in the lives of families. Your journey starts here, and we're honored to walk alongside you.

Program Details:

Dates: February 1, 2026 - May 17, 2026

Location: Project Youth Build, 635 NW 6th St, Gainesville, FL 32601

Schedule: Mondays & Tuesdays, 5:00pm - 7:00pm EST

SECTION 1: PERSONAL INFORMATION

Last Name

First Name

Preferred Name

Date Of Birth

Age group

16-17

18-24

25+

Pronouns

Race

Ethnicity

Primary Language

SECTION 2: CONTACT INFORMATION

Address

Street Address

City

State

Country

Postal Code

Phone *

Email *

Best Contact Method

SECTION 3: EMERGENCY CONTACT INFORMATION

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relationship

SECTION 4: PARENT/GUARDIAN INFORMATION (If Under 18)

Parent/Guardian Full Name

Parent/Guardian phone number

Parent/Guardian Email

SECTION 5: EDUCATION & BACKGROUND

Education level

Do you have any previous experience with birth, babies, or childcare? * (Check all that apply)

Babysitting or childcare

Caring for younger siblings or family members

Witnessed a birth

Took a prenatal or birth class

I am a parent/guardian

Volunteer work with children or families

No previous experience (and that's okay!)

SECTION 6: TECHNOLOGY & RESOURCES

Do you have access to the following? * (Check all that apply)

Do you have reliable transportation? * (Select one)

You'll need transportation to prenatal appointments, births, postpartum visits, and mentor meetings

SECTION 7: SCHEDULE AVAILABILITY

Can you commit to attending classes on Mondays & Tuesdays from 5:00pm-7:00pm EST? * (Select one)

Do you have any known schedule conflicts during the program period (Feb 1 - May 17, 2026)?

Birth support may require being on-call day and night. Are you prepared for this? * (Select one)

SECTION 8: SCHOLARSHIP CONSIDERATION

We offer scholarships based on financial need. This information is confidential and helps us support students who

need financial assistance. Program tuition is Currently at $1,985.

Approximate Annual Household Income: (Select one)

Number of People Supported by This Income: * (Select one)

Are you interested in applying for scholarship consideration? * (Select one)

SECTION 9: YOUR DOULA JOURNEY - TELL US YOUR STORY!

This is your chance to share what's in your heart! There are no wrong answers here. We want to know what drives you, what excites you, and what you hope to bring to this work. Be yourself , your authentic voice is what makes you special!

Question 1: What draws you to birth work and supporting families?

SECTION 10: YOUR LEARNING GOALS

What do you hope to learn or gain from this program?

What are you most nervous or uncertain about when it comes to doula work?

Is there anything else you'd like us to know about you?

SECTION 11: PROGRAM UNDERSTANDING & COMMITMENT

I understand that this program requires:

Attending classes on Mondays & Tuesdays, 5:00-7:00pm EST

Completing 3 supervised births (day or night)

Attending prenatal and postpartum appointments with my mentor

Completing readings, reflections, and assignments

Maintaining professionalism and confidentiality at all times

I confirm that I have reviewed the program dates and location and can commit to participating: * (Select one)

SECTION 12: HOW DID YOU HEAR ABOUT US?

How did you learn about Birth Culture

SECTION 13: AGREEMENTS & ACKNOWLEDGMENTS

Acknowledgements

I certify that all information provided in this application is truthful and accurate

I understand that if selected additional forms will be required before starting the program

I give Birth Culture permission to contact me via phone, email, or text regarding this application

SECTION 14: SIGNATURE

Full Name

Signature

Clear

Date

Thank you for taking the time to share yourself with us!

We'll be in touch soon about next steps.

For questions, visit birthculture.org or contact us at [email protected]

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