Please note: This registration is for basic training and is not the PSP Employment Application. Please return to the site and look for the PSP form.
Dates of Training
April 8 - 15, 2023September 2023 Dates TBD

First & Last Name*

Telephone Number*

Email Address*

Street Address 1*

Street Address 2

City*

State*

Current Employer

Which session are you interested in?
—Please choose an option—October 2021 now closedJanuary 2022April 2022July 2022

Do you have any friends, family members or acquaintances that are currently employed by BBC? If yes, state name and relationship.

How did you hear about BBC?

Have you ever been convicted of a felony? If so, please explain the nature of the offense

Do you have any conditions or circumstances that would require role accommodations? if so,
please explain.

Previous Doula Certification? Please provide name of certifying agency and date of completion.

Do you have any previous birth, breastfeeding, or community support experience we should know about? Please explain.

Are you affiliated with any health system, as an employee or staff member? Please explain.

How will you collect supplies?
—Please choose an option—MailedPick-up AppointmentVirtual Supplies Requested

Appointment details: please include if this appointment will be for supplies, for information, or for payment. Appointments can be made at a later time by emailing a request. Be aware this is not official until confirmed. This is a request only.

Training Disclosure: This is NOT the PSP role for employment. Registration is not complete until $100.00 Deposit is paid to Birthing Beautiful Communities. In general payments can be made by pay pal (https://www.paypal.com/paypalme/birthingbeautifulcom) or mailed to our address via check / money order- no cash. Once deposits are received for 15 participants, we will close out training by email. Balance is due in full before the first day of class and before certification exam can be administered. For this particular training, payment must be made by check or money order only or electronic payment and must be made payable to Birthing Beautiful Communities with the participants name printed in the memo line along with the word training. If electronic payments are available by email request to training@birthingbeautiful.org due to issues with postal delays. Training will take place the week of April 8 - 15 and September dates TBD. Please note the training is virtual at this time and participants will need to log onto zoom daily between 1 and 6pm or 4 to 9 and if absent they will need to review the virtual classroom used for training on their own and follow along in a self directed format. Changes to timeframes and days of the week can be made if the training group decides to agree to new timeframes including evening and morning training slots. Participants will be required to sign a nondisclosure agreement and general training agreement that includes all policies. Manuals and materials are required to be returned for any person who does not make full payment by the end of their training session. Payments can be made to https://www.paypal.com/paypalme/birthingbeautifulcom . A screenshot of payment receipt must be sent to training@birthingbeautiful.org
Yes, I agreeNo, I do not agree

*Required field

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