LiquidGoldConcept Pathway 3 Accelerator Program Application

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* 1. Hello and welcome to the LiquidGoldConcept Pathway 3 Accelerator Program Application.

Before proceeding with this application, we strongly recommend reviewing the LiquidGoldConcept Pathway 3 Accelerator Program Frequently Asked Questions Document. This will provide a comprehensive overview of what to expect and how our program works.

I have reviewed and the FAQ Document.

I understand that LiquidGoldConcept will offer 106+ hours of directly supervised clinical hours and that I am responsible for securing ~380 hours of supervised independent practice outside of LiquidGoldConcept.

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.

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* 2. 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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* 3. Have you ever been convicted of a felony?

Yes

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

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* 5. 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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* 6. 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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* 7. 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.

Choose File

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* 8. Which of the IBLCE Required 14 Health Sciences Courses have you completed with a passing grade?

Biology

Human Anatomy

Human Physiology

Infant Child Growth and Development

Introduction to Clinical Research

Nutrition

Psychology or Counselling Skills or Communication Skills

Sociology or Cultural Sensitivity or Cultural Anthropology

Basic Life Support

Medical Documentation

Medical Terminology

Occupational Safety and Security for Health Professionals

Professional Ethics for Health Professionals

Universal Safety Precautions and Infection Control

I am a recognized health professional

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

Yes (please describe)

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* 10. Do you currently have access to pregnant or lactating patients/clients?

Yes, and I am also looking for an IBCLC to supervise my clinical hours.

No, I do not have access to pregnant and/or lactating patients/clients. (If this option applies to you, please review the prerequisite section of our FAQ document before submitting your application.)

Other (please specify).

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* 11. Please describe the clinical setting(s) where you plan to accumulate clinical hours outside of LiquidGoldConcept.

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

Yes, the placement has 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 our FAQ and contact Kelly at kelly@liquidgoldconcept.com before submitting your application)

LiquidGoldConcept Pathway 3 Accelerator Program Application

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* 2. Contact Information

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* 3. Have you ever been convicted of a felony?

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

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

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

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

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* 8. Which of the IBLCE Required 14 Health Sciences Courses have you completed with a passing grade?

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

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* 10. Do you currently have access to pregnant or lactating patients/clients?

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* 11. Please describe the clinical setting(s) where you plan to accumulate clinical hours outside of LiquidGoldConcept.

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

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

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

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