References

If you have been asked to fill out a reference for one of the College's applicants, please use the button below to submit the reference

References

Applicant Reference Form

Name *

Name

First Name

Last Name

Email Address *

Phone *

Phone

(###)

###

####

Current Job Title / Position *

Agency or Institution Name *

Are you willing to be contacted by phone if we have further questions about this applicant? *

Yes

Please check the one that applies below *

Work Reference

Personal Character reference (non-family)

Professional Birth Reference

Student’s Full Name *

Student’s Full Name

First Name

Last Name

Compassion *

Please rate the applicant in the above skill / characteristic

Excellent

Very good

Average

Below average

N/A

Initiative / Resourcefulness *

Please rate the applicant in the above skill / characteristic

Excellent

Very good

Average

Below average

N/A

Communication skills *

Please rate the applicant in the above skill / characteristic

Excellent

Very good

Average

Below average

N/A

Interpersonal skills *

Please rate the applicant in the above skill / characteristic

Excellent

Very good

Average

Below average

N/A

Honesty / Integrity *

Please rate the applicant in the above skill / characteristic

Excellent

Very good

Average

Below average

N/A

Emotional maturity *

Please rate the applicant in the above skill / characteristic

Excellent

Very good

Average

Below average

N/A

Leadership skills *

Please rate the applicant in the above skill / characteristic

Excellent

Very good

Average

Below average

N/A

Work / study skills *

Please rate the applicant in the above skill / characteristic

Excellent

Very good

Average

Below average

N/A

Organizational skills *

Please rate the applicant in the above skill / characteristic

Excellent

Very good

Average

Below average

N/A

Time management skills *

Please rate the applicant in the above skill / characteristic

Excellent

Very good

Average

Below average

N/A

Stress management skills *

Please rate the applicant in the above skill / characteristic

Excellent

Very good

Average

Below average

N/A

Tolerance of different viewpoints *

Please rate the applicant in the above skill / characteristic

Excellent

Very good

Average

Below average

N/A

Potential as a professional midwife *

Please rate the applicant in the above skill / characteristic

Excellent

Very good

Average

Below average

N/A

How long have you known the applicant, and in what capacity? *

Please tell us about any personal attributes the applicant has that would help them succeed in midwifery school, and eventual practice as a professional midwife. *

Please describe any academic skills and/or performance of the applicant in the capacity you are familiar with, that would contribute to the applicant's success in the midwifery program. *

Please describe what you know about the applicant’s abilities to manage stressful situations, and work in positions of responsibility. *

Verify information *

By selecting AGREE below, I hereby certify that all provided information is correct and true to the best of my knowledge.

AGREE

Thank you!

Application

Upcoming semester date

Fall 2018 begins August 22, 2018

Fields with asterisks * are required

Name *

Name

First Name

Last Name

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address *

Phone *

Phone

(###)

###

####

Date of Birth *

Date of Birth

YYYY

Semester you are applying *

Consent *

By checking this box, I consent to communicate and do business electronically with Mercy In Action. I understand that this business will include (but is not limited to) admissions, financial aid correspondence, general correspondence, etc.

I agree

Level of Education *

Choose the highest level of education you have obtained. If you have a foreign equivalent of one of these options, please choose "other" and explain in your biography. Send us your High School Transcripts showing graduation, and a copy of your diploma. If you have completed a college degree or any college credits, please have official copies of your transcripts sent to info@mercyinaction.com

College or University graduated from:

Exact name of Degree:

Have you ever been convicted of a felony or misdemeanor? *

Yes

If you answered yes above, please explain

How did you hear about Mercy In Action? *

Do you know anyone who has attended in the past? *

Please tell us the name of any former or current students you know who have or are attending a Mercy In Action training. If none, write "none"

Health care involvement *

Are you currently involved in any form of health care? If none, write "none"

Have you completed a doula training course? *

If Yes, submit proof of completion to info@mercyinaction.com

Yes

Have you completed any other relevant training, such as childbirth educator, lactation counselor, birth assistant, CPR, or NRP? *

If Yes, submit proof of completion to info@mercyinaction.com

Yes

Have you ever attended any births? *

Yes

If you answered yes above, how many have you attended?

< 5

5 - 10

11 - 25

> 25

Have you identified a possible clinical preceptor in your community? *

Yes

Do you have a commitment from a preceptor in your community? *

Yes

Please describe the legality and licensing requirements for midwifery in your state (or the state in which you plan to practice following graduation) *

Essay Requirement

We value strong writing skills in applicants to the College of Midwifery. We ask that you would take the time to carefully answer the following questions in short essay format. Please proofread for errors. We highly recommend that you draft your essays in your own word processing software, then copy and paste into the fields below

Please describe any previous schooling, travel, missions work, involvement in local community service, hobbies/interests, etc. *

How have your life experiences led to your decision to apply to Mercy In Action? *

Why do you want to become a midwife? *

What are your expectations for this midwifery program? *

Please describe any birth work that you have already done, if applicable, and in what capacity you attended these births (doula work, volunteer, family member, etc). *

What do you see as your most significant challenges or obstacles to completing your midwifery education and the significant demands of an on-call midwifery lifestyle? *

Please describe your plans for meeting these challenges. *

What are your goals and dreams for after you become a midwife? *

Tell us anything else you would like us to know about you, including why you think you are a good candidate for the Mercy In Action College of Midwifery. *

References *

We require a minimum of two references: a character reference, a work reference, and a professional birth reference if applicable. Please have a character reference sent on your behalf from someone who has known you longer than one year, and can speak to your ability to interact well with others. Please have a work reference sent from someone who has supervised you within the past two years, and can speak to your ability to work hard and serve others. Professional birth reference: If you have attended any births in the role of doula or midwife’s assistant, please have a reference sent from a doula or midwife you have worked with. Please note that family members are not acceptable references. Reference forms are completed online from this same webpage. By selecting "Agree" below, I verify

Agree

Application Fee

AFTER COMPLETING THIS APPLICATION, CLICK “PAY APPLICATION FEE” BUTTON ON THIS SAME PAGE AND ENTER PAYMENT OF $100

I confirm that I have read the STUDENT HANDBOOK AND COURSE CATALOG *

Agree

I confirm that I can meet the physical and mental demands of a midwife as described in the STUDENT HANDBOOK AND COURSE CATALOG *

Agree

Application Checklist *

Review this checklist to ensure that your application is complete

Completed application form

References

Copy of High School transcript

Copy of High School diploma or GED if transcript does not clearly state “Graduated”

Copy of College transcript if applicable

Application fee ($100)

Recent photo (head & shoulders)

Thank you!

Pay Application fee