Name

First Name

Last Name

Phone Number

Date of Birth:

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Why do you want to become a Lamaze Certified Childbirth Educator and what do you hope to gain from this training?

In what capacity would you like to serve birthing people and their families?

How do you see yourself creating change through childbirth education?

How will this scholarship help you with your future goals?

Describe your plans for working as a Lamaze Certified Childbirth Educator (LCCE) and how it will enhance the reach of Lamaze in your community

Do you identify as Aboriginal or Torres Strait Islander?

Aboriginal

Torres Strait Islander

Do you speak any languages other than English?

If Yes, Please tell us the language you speak

Please submit any additional information, including financial barriers, personal circumstances, community that you plan to serve, etc., that you would like the review committee to consider with your application.

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Lamaze Australia acknowledges the traditional owners of country throughout Australia and recognises their continuing connection to land, waters and culture. We pay our respects to their Elders - past, present and emerging.

Lamaze Australia also recognises the traditional birthing wisdom of Aboriginal and Torres Strait Islander peoples and the importance of reinstating birthing on country.

Lamaze Australia is a registered charity and not-for-profit organisation
"Lamaze" is a registered trademark of Lamaze International, Inc.

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