Birth Justice Warriors Application

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Thank you for your interest in becoming a Birth Justice Warrior.
We look forward to reviewing your application.

The application will be open until midnight October 12.
Successful applicants will be notified of their acceptance into the training workshop by October 15.
The Birth Justice Warriors Training Workshop will be held from 10 am to 2 pm on October 24 at
Nassau NFP - Visiting Nurse Service of New York, 375 N Broadway, Suite 101 Jericho, NY 11753.

Email *

Full Name *

Phone Number *

How do you identify your race/ethnicity? *

White

Hispanic or Latino

Black or African American

Asian

American Indian or Alaskan Native

Native Hawaiian or Pacific Islander

Other:

Required

Occupation *

How many years of experience do you have in this field? *

Less than 1 year

I-5 years

6-10 years

10-15 years

16 years or more

What experience do you have with peer health education? *

What experience do you have with pre-natal care and/or pre-natal health education? *

Why would you be interested in being a Birth Justice Warrior in your community? *

How would you describe your comfort level with public speaking? *

Extremely uncomfortable

Mildly uncomfortable

Comfortable

Very comfortable

I am a pro at public speaking

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