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Building Perinatal Support Professionals Mentor Form
The Building Perinatal Support Professionals Project (BPSP) is designed to have Certified Childbirth Educators or Doulas serve as mentors to guide, support and inspire participants. The goal of the mentors will be to help the BPSP participants develop the attitudes and skills needed to become successful in their chosen profession.
Name *
Your answer
Phone Number *
Your answer
Email *
Your answer
Mentor Requirements
• 21 years of age and older
• Certified childbirth educator or doula
• Prefer someone that is open to mentoring up to three (3) mentees
• Prefer a minimum of five (5) years in practice
• Open to working with people from diverse backgrounds
• Adhere to all program policies and procedures
• Remain unbiased on credentialing pathways
• Dependable and consistent in meeting the time commitments
I understand that I must meet the requirements listed above to be selected as a mentor.
Time Commitment
• Must be willing to have 6 touch points (via face-to-face meeting, telephone or email) with mentees between July, 2017- June, 2019 to keep abreast of progress or setbacks
• Participate in an initial mentor orientation via webinar/or phone
• Attend program recognition events as available
I understand the time commitment required for the BPSP mentor and that my active participation is essential to the success of the program
What is your profession?
How long have you been in practice?
Are you willing to have more than one mentee (no more than 3)?
Please provide your website url or social media handles, if possible.
Your answer
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