AMANI Birth Childbirth Educator/Doula Training Application
English:
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
First_Name *
Nama depan
Your answer
Last_Name *
Nama terakhir
Your answer
Workshop_Location *
Please select the location of your choice.
Email *
Your answer
Nationality *
Keangsaan
Your answer
Occupation *
Pekerjaan
Your answer
Country_of_Residence *
Your answer
Phone_Number *
Nomer Telpon
Your answer
What_is_your_first_language? *
Your answer
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.) *
List_any_other_languages_you_speak.
Your answer
Religion *
Agama
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)
Required
Why_do_you_want_to_train_with_us? (Mengapa Anda mau bergabung dg AMANI Birth?) *
Select all that apply. (boleh memilih semuanya)
Required
Who_influenced_you_most_to_attend? (Siapa yang mempengaruhi Anda untuk bergabung?) *
Select all that apply.(boleh memilih semuanya)
Required
Are_you_able_to_attend_classes_in_Delaware? *
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
Your answer
What_do_you_need_most_help_on? *
Apa yang sangat Anda butuhkan?
Your answer
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?
Do_you_have_special_needs_for_training?
Apakah Anda mempunyai kebutuhan lain selama pelatiha?
Your answer
Please_tell_us_why_you_feel_your_application_should_be_accepted: *
Tolong beritahu ke kami mengapa aplikasi Anda seharusnya kami terima?
Your answer
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 http://www.amanibirth.com/training-program-overview for more details about the certification process. Thank you, again, for your interest in AMANI Birth!
Did_you_complete_this_application_yourself? *
Enter_Your_Promotion/Discount_Code_Here
Your answer
Did a registered AMANI student refer you?
Enter her student number or name so that we may thank her for referring you!
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service