LiquidGoldConcept Pathway 3 Global Mentorship Program Application

Welcome to the LiquidGoldConcept Pathway 3 Global Mentorship Program Application.

What is included in the LiquidGoldConcept Pathway 3 Global Mentorship Program?

103 hours of clinically-rigorous training through telesimulations with standardized patients, independent study modules, and group discussions (Lactation Education + Communication Hours) over 4 months
Virtual mentorship from diverse IBCLCs with two face-to-face interactions per month & unlimited text-based support for the supervision of your independent lactation practice for 12 months
A global network of aspiring IBCLC peers and practicing IBCLCs forming the Alumni Success program
Certification as an Advanced Lactation Specialist (cALS)

What is not included?

Clinical hours provided via telesimulation with standardized patients

Please be sure to review the LiquidGoldConcept Pathway 3 Global Mentorship Program Overview and/or speak to a representative from LiquidGoldConcept before submitting this application. Note: there will be no refunds on the $200 application fee.

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* 1. Contact Information

First Name and Last Name *

Address Line 1 *

Address Line 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Email Address *

Phone Number *

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* 2. Which degrees have you obtained? What years were these degrees obtained?

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* 3. Please upload a copy of your transcript from a college, university, or accredited other program of higher education.

Please provide a copy of your diploma/final transcript.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 4. Are you a healthcare professional (physician, nurse, or allied health professional)?

If yes, please provide a copy of your diploma/final transcript.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 5. Are you currently enrolled in a program that will grant you a degree as a healthcare professional?

If yes, please provide a scan/photo of your current student ID.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 6. Have you completed the required 14 Health Sciences Courses with a passing grade of 'C' or above in each course?

Yes.

No, I am an IBLCE recognized health professional and am exempt from this prerequisite.

No, not yet.

If you have not yet completed the required prerequisites, please elaborate on which courses you have remaining, and/or provide us with any additional details.

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* 7. Do you have any lactation certificates or additional training in lactation?

Yes (please describe)

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* 8. Have you already completed 90 hours of lactation-specific education?

Yes. (Please describe)

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* 9. Please describe in detail the clinical setting(s) where you plan to accumulate clinical hours under the virtual supervision of LiquidGoldConcept IBCLCs.

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* 10. Have you already secured your placement at the setting(s) you listed above?

Yes, the placement(s) have been secured.

Not yet, but I am currently formalizing my placement at the setting(s) listed above.

No, I have not yet secured my placement and I would like some assistance in doing so. (If this option applies to you, please review the Ideal Candidate Profile in the LiquidGoldConcept Pathway 3 Global Mentorship Program Overview and contact Kara at kara@liquidgoldconcept.com before submitting your application)

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* 11. Describe why you have chosen to become an IBCLC.

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* 12. Anything else you would like to share? Questions?

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* 13. Please confirm you have reviewed the prerequistes for the LiquidGoldConcept Global Mentorship Program.

I have reviewed and the LiquidGoldConcept Pathway 3 Global Mentorship Program Overview document.

I understand that I must have written and oral proficiency in English.

I understand that I must have completed and passed the 14 health sciences classes required by IBLCE, be a healthcare professional, or be enrolled in a degree-granting program as a healthcare professional.

I understand that I must have access to pregnant or lactating clients/patients so that I can accumulate at least 10 clinical hours per week starting January 1, 2022.

I understand that I must submit proof of current CPR certification (fee dependent on profession, certificate, country, etc.)

I understand that I must submit proof of a national background check (fee dependent on profession, certificate, country, etc.).

I understand that I must submit proof of liability/malpractice insurance (fee dependent on profession, certificate, country, etc.).

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* 14. Please confirm you understand the format of the LiquidGoldConcept Pathway 3 Global Mentorship Program.

I understand that I will not receive clinical hours for completing LiquidGoldConcept telesimulations.

I understand that I will be required to complete 103 hours of telesimulations and associated assignments and receive a passing grade (80%) to receive access to mentorship from LiquidGoldConcept IBCLCs.

I understand that I am required to have access to my own pregnant or postpartum patients to participate in the Pathway 3 Global Mentorship Program.

I understand that I am required to meet twice a month via video-conferencing platform with a LiquidGoldConcept-affiliated IBCLC to orally present a past patient/client’s case and discuss my management of that patient/client.

I understand that I am required to send at least one patient/client care question per week via LiquidGoldConcept’s communication platform. LiquidGoldConcept-affiliated IBCLCs will respond to written inquiries about patient/client care in a timely manner.

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* 15. Please confirm you understand the fees associated with applying to and participating in the LiquidGoldConcept Pathway 3 Global Mentorship Program.

I understand that there is a one-time $200 (USD) fee to apply to this program. This fee is used to create a Pathway 3 Mentorship Plan and submit to IBLCE for approval. This is non-refundable.

I understand that IBLCE requires a separate $100 (USD) non-refundable payment upon submission of my Pathway 3 Mentorship plan.

I understand that there will be a separate fee submitted to IBLCE when I apply to sit for the IBCLC Exam.

I understand that the cost to complete the LiquidGoldConcept Pathway 3 Global Mentorship Program is $4995, which must be paid in full by July 30, 2021 as one installment of $4795 ($4995 minus $200 application fee).

I understand that the drop deadline is August 15, 2021. After this date, I will no longer be eligible to receive a refund for paid tuition if I decide not to participate in the program.

I understand that LiquidGoldConcept is not able to offer scholarships for the LiquidGoldConcept Pathway 3 Global Mentorship Program at this time.