Application for San Diego Breastfeeding Coalition Lactation Scholarship
Please fill out this form to complete the application.
Sign in to Google to save your progress. Learn more
Email *
Name *
Phone *
Address *
Select Desired Program: *
Required
Please tell us what languages you fluently speak *
Education (Include Dates) *
Credentials *
Work Experience (include dates): *
Volunteer Experience (include dates): *
Other skills: *
Briefly explain your plans for the future: *
Provide a detailed account of how you plan to use the knowledge and skills you will gain as a Lactation Educator Counselor (LEC) or a Lactation Consultant: *
Explain how you are suited to providing breastfeeding support to the population that you would serve: *
Explain how you would promote interest in learning about breastfeeding amongst your coworkers or community: *
If you would use your Lactation Educator Counselor or Lactation Consultant knowledge and skills in your current place of employment, please also attach a letter of recommendation from your employer. This letter should address: 1) Why you are a good candidate for this scholarship 2) What opportunities you will have to use the knowledge and skills that you will gain from becoming a Lactation Educator Counselor or a Lactation Consultant and 3) How this fits with your organization’s goals to support breastfeeding. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of San Diego County Breastfeeding Coalition. Report Abuse