Mentor Application
You must be member of either Georgia Midwifery Association or National Association of Certified Professional Midwives: Georgia State Chapter. Mentors may be students enrolled in a CPM program of study and apprenticeship who are advanced in their skills and learning process or CPM who have completed antiracism training modules at www.equitymidwifery.org and are able to maintain regular contact with their mentee as well as participate in clinical skills training workshops for all mentees in the program.
Name *
First and last name
Your answer
Email *
Your answer
Phone number *
Your answer
Date of Birth *
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YYYY
Address *
Your answer
Race *
Your answer
I am a member of: *
Required
If you are currently enrolled in a program of study OR completed a program of study, please list here: *
Your answer
How long have you been a student midwife OR How long have you been a CPM (please indicate which)? *
Your answer
Have you worked with students before? *
Your answer
What experiences have you had/did you have as a student midwife? *
Your answer
Have you completed antiracism training modules at EquityMidwifery.org? Are you willing to? *
Your answer
What are your main levels of expertise in midwifery? *
What are you looking for in a mentee? *
Your answer
How much time are you able to invest in your mentee?
Your answer
What skills workshops would you be most interested in teaching? *
Required
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