Terry Jo Curtis "Every Ounce Counts" Scholarship Application 2020

The Terry Jo Curtis Scholarship is for minority applicants who live and/or work in Indiana. There are expectations of some volunteer time for the coalition in the year following your scholarship that will be outlined to you in an email. You must sign an Memorandum of Understanding with IBC, in order to receive funds.

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* 1. Please provide your contact information. YOU MUST LIVE OR WORK IN INDIANA TO APPLY. Please give us an alternate email address, if possible

Name *

Workplace/Organization Name

Home Address *

Address 2 (enter N/A if not needed) *

City/Town *

State/Province *

ZIP/Postal Code *

Email Addresses (give 2 if possible) *

Phone Number *

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* 2. Are you of Hispanic, Latino, or Spanish origin or descent?

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* 3. Which race/ethnicity best describes you?

White

Black or African American

African

American Indian or Alaskan Native. Please specify Tribe in comment box, below

Asian Indian

Burmese

Filipino

Japanese

Korean

Vietnamese

Chinese

Arabic

Other Asian. Please specify in comment box below (for example, Hmong, Laotian, Thai, Pakastani, and so on)

Pacific islander. Please specify in comment box below

Other than choices above (please specify) or additional comments.

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* 4. What gender do you identify with?

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* 5. Are you currently a member of an Indiana Local/tribal/cultural breastfeeding coalition? If yes, is your primary breastfeeding coalition one of the coalitions on the Indiana Breastfeeding Coalition website? See the coalition directory

Yes, on the IBC website. Please enter name of coalition below.

Yes, NOT on the IBC website. Please enter name of coalition below.

No, not a member of a coalition. Please enter name of other organizational affiliation below.

Comments

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* 6. Please write a short paragraph that outlines why you would like to have this scholarship. Please include a few words on how you plan to use this training to improve breastfeeding education or support in a minority community of Indiana.

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* 7. What impact would this training have on you, your work, or your community?

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* 8. Please indicate which program you are interested in. Considering the limits at this point on social gatherings, we are limiting our selection mainly to online courses. Scholarships will be for cost of registration and fees up to $750. Some of these courses cost more than that. Please give details in the comment box for any choice that you make

Lacted Training (Milkmob) Online and in person trainings. Next online starts June 3. See website for details and available dates.

Online UCSD Lactation Educator training. Various dates

Lactation Education Resources Various Choices

Arizona State University Lactation Education Program 90 hour course for IBCLC requirements. Total cost is

Healthy Children CLC Online Course 52 hour course that starts when you register, and due in 6 months

Other Course (Please give details, including dollar amount, in comment box below)

Comments on course details, date of course, other courses that are not listed

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* 9. Please provide a reference for recommendation for this scholarship.

Name

Company/Organization

Email Address

Phone Number

Thank you for your interest and for your application. Please email indianabreastfeedingcoalition@gmail.com with any questions.