Student Midwife

Roots & Wings Midwifery

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Roots & Wings Student Midwife Application

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Date of Birth *

Marital Status *

Single Married Divorced Widowed Other

Do you have children? *

Yes No

If yes, how many and how old are they? *

Are you fluent in any other languages? *

Yes No

If yes, which language(s)? *

Do you have any spiritual or religious beliefs you want us to know about? *

Yes No Maybe

If yes, please explain. *

Social Media Addresses : *

What are your current credentials and/or certifications? *

How did you learn about our program? *

Why do you want to become a midwife? *

What are the qualities you like best about yourself and what are your weaknesses? *

What is your educational background? *

What are your plans for your midwifery education? Will you be enrolled in an MEAC school? *

Have you attended births in any capacity? Please elaborate. *

Do you have any family, work, or other responsibilities that would limit your availability as an student midwife? *

Do you have any health problems? Do you have physical conditions which might limit your ability to be on call 24/7 and work long, irregular hours? *

How much sleep do you need on a regular basis to function well? Do naps refresh you or leave you in worse shape? Are you most alert in the morning or at night? *

What is your natural approach to cleanliness (housekeeping, etc.) and organization? *

At times the demands of a student midwife can be overwhelming. Please describe how you handle stress. *

What is your history with sticking to a plan of your choice, i.e. do you know from experience that you have what it takes to focus as long as needed to accomplish your goals? *

Do you have an idea of where you would like to serve/work as a midwife once you receive your training? *

Would you have a dependable car and cell phone available? *

Yes No Maybe

Do you have the financial resources to live without making an income for the time you would be with us, plus cover the costs of your training? Please elaborate. *

What other commitments do you have in your life? How important are these commitments compared to an apprenticeship? Are you ready to work many hours per week plus be on call 24/7? *

Do you have any "boundaries"? *

Do you use any prescription medications, social (recreational) drugs, alcohol, or cigarettes? *

Do you have any skills you'd like us to know about? *

What are your hobbies? *

What are your preferred learning styles? How do you learn best? *

Would you consider yourself a self-starter or are you more comfortable with routine direction? Can you cope with very detailed instructions regarding chores, our way of doing things, and client safety, etc? *

Would you be willing to spend a couple of months on a trial period to see if we are a good fit for each other? *

If you have ever begun an apprenticeship with someone else, who was your preceptor and why didn't you complete the apprenticeship? Please provide contact information for any previous preceptors. *

Have you ever had a job? If so, please provide names and phone numbers of references. *

Submit

©2019 Roots and Wings Midwifery, LLC │ Knoxville, Maryville, Oak Ridge, Kingston, TN │ info@rootsandwingsmidwifery.com

Office Address: 4873 Chambliss Ave Knoxville TN 37919

The Team
Home Birth Services
Cycle Charting
Preparation
News
Contact
Birth Stories