AMANI Birth Childbirth Educator/Doula Training Application
Thank you for your interest in the AMANI Birth training for professional certification as a Childbirth Educator and/or Doula.  AMANI Birth is an Islamically based program, however is open to persons of all religions who are passionate about helping woman through the natural process of childbirth.  Please fill out this form online to submit your application for consideration for training.
Bahasa Indonesia:
Terima kasih telah tertarik pada Pelatihan AMANI Birth untuk sertifikasi professional sebagai Childbirth Educator and/or Doula. AMANI Birth adalah berdasarkan program keislaman, bahkan persalinan alami. Tolong diisi formulir online untuk ditambahkan ke aplikasi Anda sebagai pertimbangan untuk pelatihan. *harus diisi
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First_Name *
Nama depan
Last_Name *
Nama terakhir
Workshop_Location (Since 2020 Workshops Are Online) *
Please select the location of your choice.
Email *
Nationality *
Occupation *
Country_of_Residence *
Phone_Number *
Nomer Telpon
What_is_your_first_language? *
Do_you_speak_read_and_understand_English? (Most workshops are taught in English; however, in some regions translation is available and materials are available in Arabic, Indonesian, and German as well.) *
Religion *
Have_you_ever_taken_childbirth_classes? *
Pernah ikut serta dalam kelas kehamilan?
How_did_you_hear_about_AMANI_Birth? (Bagaimana Anda mendengar AMANI Birth?) *
Select all that apply. (boleh memilih semuanya)
Why_do_you_want_to_train_with_us? (Mengapa Anda mau bergabung dg AMANI Birth?) *
Select all that apply. (boleh memilih semuanya)
Who_influenced_you_most_to_attend? (Siapa yang mempengaruhi Anda untuk bergabung?) *
Select all that apply.(boleh memilih semuanya)
Are_you_able_to_attend_classes_in_Delaware (not required as most workshops are now online)? *
Dapatkah Anda menghadiri kelas di Delaware, USA?
If_outside_of_Delaware,_can_you_organize_a class_of_10? *
Jika diluar Delaware, USA dapatkah kamu mengelola 10 orang sekelas?
Have_you_ever_taught_childbirth_classes? *
Pernahkah mengajar kelas melahirkan?
Have_you_ever_served_as_a _Doula? *
Pernahkah menjadi Doula?
What_are_your_strengths? *
Apakah kekuatanmu
What_do_you_need_most_help_on? *
Apa yang sangat Anda butuhkan?
Do_you_know_AMANI_graduates? *
Anda tahu alumni AMANI
Will_you_bring_a_nursing_baby_to_class? (Akankah Anda menyusui bayi saat di kelas?) *
Nursing babies are always welcomed. (menyusui bayi selalu diperbolehkan)
Do_you_plan_to_teach_and_serve_as_a_Doula? *
Anda berencana mengajar dan berperan sebagai Doula?
How_many_births_have_you_attended? (Berapa persalinan yang pernah Anda hadiri?) *
Do not count your own. (Persalinanmu sendiri tidak dihitung)
Have_you_read_the_AMANI_Birth_book? *
Pernahkah Anda membaca buku AMANI?
Apakah Anda mempunyai kebutuhan lain selama pelatiha?
Please_tell_us_why_you_feel_your_application_should_be_accepted: *
Tolong beritahu ke kami mengapa aplikasi Anda seharusnya kami terima?
Statement_of_Understanding: *
By submitting this electronic application you authorize AMANI Birth to contact you to complete your enrollment in an upcoming workshop. We suggest you visit for more details about the certification process. Thank you, again, for your interest in AMANI Birth!
Did_you_complete_this_application_yourself? *
Did a registered AMANI student refer you?
Enter her student number or name so that we may thank her for referring you!
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