Milkwell® Mentorship Application

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Thank you for expressing interest in applying for mentorship to complete the lactation clinical hours required to sit the board exam for IBLCE. We are excited to learn more about you and how you might fit into our practice. Please complete the following form.

Email *

Application date *

YYYY

First & last name *

Address *

Phone number *

Which pathway are you pursuing?
*

If Pathway 3, has your plan been verified and approved yet?

yes

Clear selection

When are you anticipating sitting for the IBLCE exam and what are you plans or hopes for lactation work when you have received your credential? *

Which of the required college courses have you completed? Please be aware that completion of the required college courses is NOT REQUIRED to be completed prior to beginning mentorship in my practice.
*

Which program did you use for the lactation specific education and how many hours have you completed? Please be aware that all the required lactation specific hours ARE REQUIRED to be completed prior to beginning mentorship in my practice. This is not an IBLCE rule.
*

Is your CPR up to date?
*

Yes

How many days a week and hours a day do you anticipate being available for your mentorship? Do you have specific days you are available? Please understand that there is no guarantee date of completion of hours. We cannot guarantee how many clients will schedule sessions each day so we cannot guarantee hours to you. However, there may be additional ways of secure your hours if client facing hours are not adequate. *

We will have opportunities for you to participate in your clinical hours with any IBCLCs on staff. This allows you the opportunity to experience different counseling and communication styles as well as varied methodologies. We also welcome you to find other mentors in the community to support your preferred exam timeline. IBLCE does allow for more than one mentor.

I understand

Clear selection

Mentorship does require some participation within the practice outside of client-facing care such as co-facilitating workshops, support groups and community events like our booths at Jazz Fest, Pride and Clifton Community Baby Shower. We also have regular team meetings for networking and educational opportunities. You will only be required to participate in team case review and group mentorship opportunities. You will not be required to attend everything but some attempt to show up for some events is highly encouraged as experience teaching, facilitating group work and engaging with the community is an important part of being a well rounded lactation professional.

I understand and agree to attend as often as my schedule allows

I understand and will likely not be able to attend many events

You will need to have a professional liability policy to cover yourself during mentorship. CM&F Group has accessible rates. Please be sure to add me, Jennifer Kowal, Milkwell Lactation + Feeding Solutions, and the office address as an Additional Insured to your policy and provide me with a copy of the Certificate before starting.

I understand

Because IBLCE changes the exam pre-reqs every few years, please understand that mentees themselves are required to be knowledgable and up to date on the latest requirements for your application to sit the IBLCE exam and that mentorship within Milkwell in no way guarantees you will be approved to sit the exam or pass the exam. *

I understand

Our clinical supervision services include fees for service to reflect the comprehensive support provided to our mentees/students. These fees cover the time, expertise, and resources dedicated to training, educating, counseling, and guiding students to ensure a high standard of professional development and client care. Payment plans do exist.

I understand

Clear selection

Please understand that unless otherwise stated, submission of this application is not a guarantee acceptance into the Milkwell Mentorship program. When you have been accepted you will receive an acceptance letter outlining pertinent details, contracts, and waivers to sign. *

I understand

Send me a copy of my responses.

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