Application Form - Health e-Learning

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Formal Educational Achievements(*)

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What is your experience as a breastfeeding counsellor? Describe your training program, years of experience and tasks you now undertake in that role. (max ½ page)(*)

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How will you give back to your community once you reach your goal of becoming an IBCLC?(*)

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Referee Details

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Position(*)

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Support documents for your application

Letter of Recommendation(*)

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Proof of my position with my volunteer breastfeeding group(*)

Proof of my clinical lactation experience(*)

Additional Document (optional)

By submitting this application I agree to the terms and conditions of the scholarship and I confirm that:(*)

I have completed my application and the information I have provided is truthful.

I have attached a reference letter from my referee and my referee has agreed that you may contact them about my application, if necessary.

I have included proof of my position with my volunteer breastfeeding group and/or my clinical lactation experience.

I understand that if my application is incomplete I will not be eligible for the scholarship

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Scholarship Application Form

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