Application for BRC Mentorship Program
Thank you for your interest in the BRC Mentorship Program!
1.
What is your first name?
2.
What is your last name?
3.
What is your phone number?
4.
At what email address would you like to be contacted?
5.
What is your home address?
6.
What is your current job/related experience?
7.
What IBLCE Pathway do you intend on following?
Pathway 1: Healthcare Professional, will need 1000 lactation specific clinical practice in an appropriate supervised setting
Pathway 2: Accredited Lactation Academic Program along with 300 directly supervised lactation specific clinical practice
Pathway 3: Mentorship with an IBCLC along with 500 directly supervised lactation specific clinical practice
8.
Have you completed your 95 hours of lactation-specific education? If yes, which program did you complete?
9.
Have you completed your health sciences education/14 college-level classes?
Yes
No
10.
Which days are you available? Please note: availability on weekends is very limited.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
11.
How many number of days per week are you willing to commit to this mentorship program?
12.
When do you hope to sit for the exam? Month? Year?
13.
When do you expect to apply for the exam? (All clinical hours must be completed before applying to IBLCE)