Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email Address
*
Telephone
(###)
###
####
Cellphone
(###)
###
####
Fax (if applicable)
(###)
###
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Who are you?
*
The Hilary Marentette Scholarship is only available to NSDA Certified Members. If you are a Certified Doula and would like to be eligible for the Hilary Marentette Scholarship, please submit your membership form to be considered eligible.
Title of the Event
*
Scheduled Date (must be in the next 12 months)
*
MM
DD
YYYY
Location
*
Brief Description (provider, trainer, outline, workshop objective, CEUs, etc.)
*
Please outline any other costs (if any) that you may encounter by attending this workshop (travels costs, accommodations, books & supplies, etc.)
*
Are you applying for funding anywhere else? If so, where and how much?
Please submit the following documents by email to education@novascotiadoulas.org
*
Please make sure to write "Hilary Marentette Scholarship Application" as the title of your email when providing your supporting documents (see the bottom of this form). Make sure to include your Contact Information in the body of the email when you submit your documents. All documents should be received before April 20th, 2018 at 11:59pm. Your application will only be considered for this award once all of the documents have been received.
