Six-in-One Death Doula Training Application - Momdoulary Death & Mourning Doula Training Program

NOTE: If you are an educator or institution interested in offering death and mourning doula training, we do offer the opportunity to bring our training to your institution – email us at momdoulary@gmail.com for more information. Do know that enrollees are required to sign an Enrollment Agreement that contains extensive non-disclosure/non-compete agreements, which prevent them from sharing or offering a similar training or certification program for doulas – as you can well understand, we protect our intellectual property!

Admission Application

Application for Admission to Momdoulary Death Doula Training for Certification Momdoulary is an Equal Opportunity Educational Program committed to excellence through diversity. Admissions are made on the basis of qualiﬁcations and without regard to race, sex, religion, national or ethnic origin, disability, age, veteran status, or sexual orientation.
Name (last, first, middle) *
Other names under which you have attended school or been employed:
Email *
Phone *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Which program are you applying for? *
Are you 18 years of age or over? *
yesno
Are you related to any current Momdoulary employee?
yesno
If YES, their name & their relationship to you?
Do you currently hold any related certification? If yes, what?
Driver License or State ID # *

EDUCATION

Highest level of education completed, include certifications, etc *
Name of School:
City and State where School is Located
Did you graduate:
yesno
If yes, graduation date and major
If Yes, date of Graduation and Major:
Degree received:
Please list any other schooling and degrees you have completed:
Other credentials/ licenses/ professional afliations, etc., which are relevant to the job(s) for which you are applying.

Work Experience

Please detail your related work history. Begin with your current or most recent employer. Include full-time military or volunteer commitments.
Please describe related work experience, including length of time and role

ADMISSION ESSAY QUESTIONS

What is your experience with death and loss? Have you ever been present when someone has died? Lost loved ones? Provided support to the dying in any professional capacity? Give us a glimpse into your personal experience.
From your perspective, what is the Mourning Doula's Role for a Grieving Family?
From your perspective, what is the Death Doula's role, and how do they help individuals more fully embrace life?
What are some of the challenges of supporting someone in a non-biased way, and how would you best handle it when a client wants you to support them in a situation that you would never imagine choosing?
Have you talked with loved ones about your own eventual death, and how you want end-of-life care and funeral arrangements handled? If no, why not? If yes, what was the biggest challenge?
When grieving, we are vulnerable and at greater risk of being taken advantage of. Explain how you see Mourning and Death doulas helping protect individuals.
What is the most recent loss you've experienced? When did it occur, and where do you think you are in the grieving process?

Agreement

I submit that
by submitting this application I am acknowledging all of the following: 1. I am not an employee of a Momdoulary. 2. I will be responsible for internet connectivity, telephone connectivity, and computer access on my side. 3. I will participate in mandatory orientation activities and classroom participation. 4. I understand that Momdoulary does not provide any type of insurance and that it is recommended I obtain doula, coach, and organizer insurance for the duration of the training. 5. I understand Momdoulary cannot guarantee a set income or employability - this is a skills training program, but I am responsible for creating my own work environment and circumstances. 6. I understand that Momdoulary is a Limited Liability Company PLEASE READ CAREFULLY AND SIGN THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION. I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration if discovered at a later date. I authorize Momdoulary to investigate, without liability, all statements contained in this application and supporting materials. I authorize references to make full response to any inquiries in connection with this application. Type "YES" below to acknowledge this

Verification

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