"A Wave of Midwifery" Intake Survey
1.
What is your name and the best phone number and email address for you?
2.
What city and state do you live in?
3.
What grade are you entering this Fall?
9th grade
10th grade
11th grade
12th grade
Age
4.
Tell us what you enjoy doing for fun? Some examples might include games you enjoy, family/friend activities, self care, or anything else you would like to share!
5.
How would your friends/family describe you?
6.
Have you considered a career in healthcare? If yes, what type of career? (dentistry, nursing, therapy, doctor, EMT/CNA or any other career paths you have considered).
7.
Based off your own understanding, what do you think a midwife is? Try not to use the internet for this, only your prior knowledge.
8.
What would you want to learn about midwifery?
9.
We plan to meet one Saturday per month for 90 minutes from September to December. Will you be able to commit to this?
Yes
No
Other (please specify)
10.
Will you be respectful of other participants and facilitators of the group?
What do you need from the facilitator to help us create a safe learning environment?
Yes
No
Other (please specify)
Current Progress,
0 of 10 answered