Hawaiʻi Indigenous Breastfeeding Counselor Training Application

HI IBC Training Application

Aloha mai,

Mahalo for your interest in attending the Hawaiʻi Indigenous Breastfeeding Counselor training in Waimānalo from October 14-18, 2019. We are excited to host this event and look forward to your application. Mahalo to our sponsors: Hawaʻi Department of Health, Breastfeeding Hawaiʻi, Waimānalo Health Center, Office of Hawaiian Affairs ʻAhahui Grant, and CalMed Hawaiʻi for their generous donations of space and funding for participant fees and food during the training.

We are working toward offering a stipend to kōkua neighbor island participants to attend; we encourage applicants from all islands to apply. The application period will be open until all seats are filled. Upon receiving a completed application, Breastfeeding Hawaiʻi will respond within 2 weeks of either acceptance or being placed on the waiting list. Waiting list applicants will be notified no later than September 13 if they are confirmed for the training.

First priority will be given to those who identify as Native Hawaiian. We want to make it clear this space is solely reserved for persons identifying as indigenous and we want to ensure them a safe space. We will not be responding to inquiries about participation by persons who do not identify as indigenous.

Please contact us at IBCHI@bfhawaii.org with any questions.

Mahalo!

Breastfeeding Hawaiʻi

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* 1. Your contact info:

First Name

Last Name

Preferred Name

Organization Name (if any)

Job Title

Email Address

Phone Number

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* 2. Does your phone receive text messages?

Yes

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* 3. In what year were you born? (enter 4-digit birth year; for example, 1976)

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* 4. Which gender do you identify with?

Female

Male

Transgender

Genderqueer

Prefer not to answer

Other (please specify)

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* 5. What is your zip code?

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* 6. What island do you live on?

Niʻihau

Kauaʻi

Oʻahu

Molokaʻi

Lānaʻi

Mauʻi

Hawaiʻi Island

Other (please specify)

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* 7. Which indigenous ethnicity do you identify with?

Native Hawaiian

Samoan

Tongan

Fijian

Tahitian

Maori

Guamanian

Chamorro

Marshallese

Chuukese

Palauan

Indigenous Australian

Alaska Native

Native American

Other (please specify)

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* 8. Please share your experience with supporting breastfeeding in your community, if any (250 words max).

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* 9. How do you feel this training will help you support mothers to breastfeed and continue breastfeeding in your community (250 words max)?

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* 10. How do you plan to implement breastfeeding support in your community with the knowledge and connections you gain from the Indigenous Breastfeeding Counselor training (250 words max)?

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* 11. Are you requesting financial support for the following expenses?

Flight

Transportation

Housing

None of the above

Other (please specify)

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* 12. Can you commit to all five days of the training - October 14-18, 2019? (*The IBC designation will be given to those who attend and complete the full 5-day training).

Yes

I'm not sure