Strong Families AZ IBCLC Opportunities Survey

International Board of Lactation Consultant Examiners (IBCLE) has established methods by which individuals may fulfill the eligibility criteria for the certification examination. Strong Families AZ is looking at working with Home Visitors to make this a possibility. If interested, please answer a few short questions below. ADHS staff will evaluate your answers and work with you/manager to build an individual plan.

Question Title

* 1. All first-time candidates must demonstrate completion of education in 14 subjects that are typical of
the education required of health professionals. This general education must be completed prior to
applying for the exam.

The rationale for requiring all exam candidates to complete education in these subjects is to establish
that they have the foundational education necessary to function as valued, respected members of the
maternal-child health care team.

Please select the college level/continuing education courses that you have completed.

	College	Continuing Education	Other
Biology	Biology College	Biology Continuing Education	Biology Other
Human Anatomy	Human Anatomy College	Human Anatomy Continuing Education	Human Anatomy Other
Human Physiology	Human Physiology College	Human Physiology Continuing Education	Human Physiology Other
Infant and Child Growth and Development	Infant and Child Growth and Development College	Infant and Child Growth and Development Continuing Education	Infant and Child Growth and Development Other
Introduction to Clinical Research	Introduction to Clinical Research College	Introduction to Clinical Research Continuing Education	Introduction to Clinical Research Other
Nutrition	Nutrition College	Nutrition Continuing Education	Nutrition Other
Psychology/Counseling Skills/Communication Skills	Psychology/Counseling Skills/Communication Skills College	Psychology/Counseling Skills/Communication Skills Continuing Education	Psychology/Counseling Skills/Communication Skills Other
Sociology/Cultural Sensitivity/Cultural Anthropology	Sociology/Cultural Sensitivity/Cultural Anthropology College	Sociology/Cultural Sensitivity/Cultural Anthropology Continuing Education	Sociology/Cultural Sensitivity/Cultural Anthropology Other
Basic Life Support	Basic Life Support College	Basic Life Support Continuing Education	Basic Life Support Other
Medical Documentation	Medical Documentation College	Medical Documentation Continuing Education	Medical Documentation Other
Medical Terminology	Medical Terminology College	Medical Terminology Continuing Education	Medical Terminology Other
Occupations Safety and Security for Health Professionals	Occupations Safety and Security for Health Professionals College	Occupations Safety and Security for Health Professionals Continuing Education	Occupations Safety and Security for Health Professionals Other
Professional Ethics for Health Professionals	Professional Ethics for Health Professionals College	Professional Ethics for Health Professionals Continuing Education	Professional Ethics for Health Professionals Other
Universal Safety Precautions and Infection Control	Universal Safety Precautions and Infection Control College	Universal Safety Precautions and Infection Control Continuing Education	Universal Safety Precautions and Infection Control Other

Question Title

* 2. How many hours of lactation specific education have you completed in the last five (5) years?

Under 16

17-30

31-45

46-60

61-75

76-90

91+

Question Title

* 3. How many hours have you worked with moms/babies in the last 4 years on breastfeeding?

One on One, as part of your job

One on One, as a volunteer

Teaching breastfeeding to a group

Telephone, email, or web-based breastfeeding support

Question Title

* 4. Do you think that your employer would support you in seeking this designation with:

	Yes	No	Maybe
Exam Fees	Exam Fees Yes	Exam Fees No	Exam Fees Maybe
Paid time to complete exam requirements	Paid time to complete exam requirements Yes	Paid time to complete exam requirements No	Paid time to complete exam requirements Maybe
Paid time to participate in learning sessions	Paid time to participate in learning sessions Yes	Paid time to participate in learning sessions No	Paid time to participate in learning sessions Maybe
Paid time to take exam	Paid time to take exam Yes	Paid time to take exam No	Paid time to take exam Maybe
Paid time to study	Paid time to study Yes	Paid time to study No	Paid time to study Maybe
Travel expenses for learning sessions	Travel expenses for learning sessions Yes	Travel expenses for learning sessions No	Travel expenses for learning sessions Maybe
Travel expenses to take exam	Travel expenses to take exam Yes	Travel expenses to take exam No	Travel expenses to take exam Maybe

Question Title

* 5. Please share your contact information:

Name: *

Program: *

Address:

City/Town: *

State:

ZIP:

Email Address: *

Phone Number: