Citywide Doula Initiative (CDI) Participant Form
City of New York Doula Expansion Program for all NYC-based Mama Glow Doulas
First Name *
Last Name *
Phone Number (Area Code + Number) *
Birth Date *
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DD
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Which of the 5 boroughs do you live in?
Which of the areas do you serve as a doula? *
Required
What is your FULL address including your zip-code? *Only complete addresses will be processed. *
Please indicate which training programs you have completed through Mama Glow. *
Required
Are you a Doula Trainee or a Certified Doula? *
Required
How many births have you attended? *
What services are you capable of offering? *
Required
Apart from English, what language(s) do you speak? *
Required
Are you available to support birthing clients from November -May 2023? *
Required
How many CDI clients can you take on monthly? *
Can you attend virtual CDI Model training and monthly CDI meetings?  *
Required
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