Dates: April 26, 27, 28; May 4 and 5

Time: 9:00 AM - 4:30 PM


Developing Families Center
801 17th Street NE
Washington, DC 20002

Deadline: April 8, 2019

Contact Information:

Name:
Mailing Address:
City:
State: Zip:
Phone Number:
Email Address:
Employer:
Occupation:
Commitment: I am committed to attending all 5 sessions of the course
I am unable to attend all 5 sessions of the course
Dietary Restrictions: I have no dietary restrictions.
I have the following dietary restrictions:

IBCLC Exam I plan to sit for the IBCLC exam in 2019

Emergency Contact:

Name:
Phone:
Relationship:


In an effort to help improve the diversity of the lactation consultant profession, this course is available at a reduced cost of $100.00 for individuals from under-represented groups and employees of eligible birthing facilities through a collaborative agreement between the DC Breastfeeding Coalition (DCBFC) and Reaching Our Sisters Everywhere (R.O.S.E.). To apply for a scholarship, please complete the following application. Upon acceptance, you will receive a link to submit your payment.
Gender?
Female
Male
Non-binary
Other
Prefer not to say
What are your preferred personal pronouns?
(Check all that apply):

She, her, hers
He, him, his
They, them, theirs
Other
Prefer not to say
How do you self-identify?
(Check all that apply):

African American
Asian
Hispanic
Caucasian
African
West Indian
Native American
Other underrepresented/minority group
Are you a person who is?
(Check all that apply):

Deaf
Deaf Blind
Hard of Hearing
Blind
Low-vision
Differently-abled
Other:
None

Are you applying to take the IBLCE 2019 exam?
Yes
No
If not, will you be applying to take the IBLCE 2020 exam?
Yes
No
Which IBLCE Pathway are you selecting?
Pathway 1
Pathway 2
Pathway 3
Not Sure

Have you completed the rest of the requirements to sit for the exam? Yes
No
After taking this course, I will still need to complete the following exam requirements: (check all that apply)
Clinical Practice Hours
14 Health Science Courses
CERPs
Academic Program in Human Lactation



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P.O. Box 29214, Washington, DC 20017 • Tel 202-470-2732 • email info@dcbfc.org

Medical Disclaimer: The information presented here is not intended to diagnose health problems, breastfeeding problems, or to take the place of professional medical care. If you have persistent breastfeeding problems, or if you have further questions, please consult your health care provider. The DC Breastfeeding Coalition does not share partnership with, or have any vested interest in, any of the businesses that may appear on this site, or sites that may be accessible by links herein contained.
Last Updated: June 2018