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* 1. Please provide your contact information

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* 3. Which race/ethnicity best describes you?

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* 4. What gender do you identify with?

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* 5. Are you currently a member of a 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

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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.

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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.  Scholarships will be for cost of registration, travel and housing expenses up to $1000.

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

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

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