Scholarship Application for Recording Access to the 2021 Perinatal Mental Health Conference for Black Birth Workers, Clinicians, and Providers
This application includes the opportunity to register for the recording at a discounted rate of $50 for BI&POC perinatal providers including birth workers/doulas, mental health clinicians, educators, lactation support, midwives and doctors, public health professionals, students, and more!
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Please complete this form to request a discounted scholarship rate of $50 for viewing the recording of the 2021 Perinatal Mental Health Conference for Black Birth Workers, Clinicians & Providers.
Full Name
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Do you identify as a Black, Indigenous, Person of Color (BIPOC)?
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How did you hear about this opportunity?
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Tell us about yourself (please answer all questions): In what capacity do you work with the perinatal community? How do you plan to utilize this material in your work? How will this training enhance your work with the community?
Are there additional resources or educational opportunities that you hope Maternal Mental Health NOW could provide?
Would you like to be signed up to receive our newsletter?
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Are you interested in participating in future volunteer opportunities with our organization?
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This form was created inside of Community Partners FBO MMH-NOW.