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



Upcoming semester date

The next cohort will begin on August 4, 2020

Fields with asterisks * are required
Name *
Address *
Phone *
Date of Birth *
Date of Birth
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.
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
Have you ever been convicted of a felony or misdemeanor? *
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"
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
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
Have you ever attended any births? *
If you answered yes above, how many have you attended?
Have you identified a possible clinical preceptor in your community? *
Do you have a commitment from a preceptor in your community? *
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
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
Application Fee
I confirm that I have read the STUDENT HANDBOOK AND COURSE CATALOG *
I confirm that I can meet the physical and mental demands of a midwife as described in the STUDENT HANDBOOK AND COURSE CATALOG *
Application Checklist *
Review this checklist to ensure that your application is complete