WALC EDUCATION SCHOLARSHIP APPLICATION

In awarding scholarships, WALC does not discriminate on the grounds of race, religion, gender, disability or marital status.  

Prerequisites:
1-Currently a member of WALC in good standing and have attended at least 2 meetings and a WALC Conference.
2-A member for at least 1 year
3-Minimumof 10 CERPs (or related CEUs) during the past 2 years
4-Minimum of 300 hours of experience working with nursing mothers (not including any personal nursing experience) during the past 2 years
5-Intention to work toward IBCLC
6-Financial need

How to apply:
1-Fill in the form below
2-Answer the questions, typing your answers on a separate page or pages
3-Give the Letter or Recommendation form to two individuals who can vouch for your qualifications and ask them to send them directly to WALC
4-Send your completed application to WALC

NAME___________________________________________________________

YEAR JOINED WALC___________________

CREDENTIALS_______________________________________________

ADDRESS_________________________________________________________

CITY____________________________ STATE____________  ZIP CODE________________

PHONE (home)_______________________ (work)_______________________ (fax)______________

E-MAIL ADDRESS____________________________________________________________

Please answer the following questions on a separate paper, typewritten if possible.

Please state briefly your reasons for requesting this scholarship.
Please document how you have met the above prerequisites.
In what way(s) have you been promoting, supporting and/or protecting breastfeeding in your local community, place of employment, etc?
In what ways do you see yourself applying the education to support, promote and/or protect breastfeeding in your local community, place of employment, etc?
Please describe (or include a brochure if you have one) the course you plan to attend including who is sponsoring/offering the course, hours involved and cost.
Would you like to be involved in any WALC activity? Please explain your area(s) of interest.

IMPORTANT: Please read this statement carefully before signing:
If I fail to complete the course, I will undertake to repay the scholarship monies.

SIGNED:____________________________________________  DATE:_____________________

Send completed application to: