ATM Midwifery Training Program

Scholarship Preliminary Application

Applicant’s Name: Date:

Dear scholarship applicant,

While extremely rewarding, midwifery is a demanding career with a great deal of responsibility. If awarded the scholarship, be prepared to devote a significant amount of time over the next 2 ½ - 4 years to your education. Education is completed via a variety of methods, including distance, classroom, and competency based learning and demonstration.

Pre-Enrollment Requirements

To be considered for the ATMMTP Midwifery Training Programscholarship the applicant must be at least 18 years old and providethe followingwith thepreliminary scholarship application:

☐Proof of high school or equivalent education, with high school or home school transcripts, or a GED certificate with exam scores. A copy of a diploma is not adequate for enrollment. A college transcript will be accepted in lieu the above. Unofficial or internet downloaded copies will not be accepted.

☐The signature page of the “Readiness-Commitment Survey” (included at the end of this application.)

Additionally, to be considered a scholarship applicant must

  • Be a Texas resident
  • Be able to pay their 15% portion of the tuition and related program costs, such as textbooks.
  • A scholarship applicant must have a gross family income that does not exceed 185% of the federal income guidelines. This corresponds with WIC income guidelines. The following chart may be used to determine eligibility. Applicants with an income above these guidelines will not be considered. Proof of income is submitted in the 2nd phase of the application process.

The ATM Education Committee will screen preliminary applications. Those selected by the Education Committee will be contacted with a request to complete the application process. This includes demonstrating academic readiness with an essay (information provided at the end of this document)on the “midwifery model of care”, and supplying the following information and supporting documentation:

☐Verification of total family income (copy of previous year’s income tax return and recent check stubs

☐Verification of household expenses, if requested

☐Must have a valid driver’s license (legible color copy or photo of a US driver’s license)

☐Must be at least 18 years of age per date of birth on driver’s license

☐Two letters of reference from sources other than family. Forms will be provided for this purpose, included with the secondary application; personal letters not accepted.

The successful recipient of the scholarship will be required to provide proof of the followingprior to enrollment:

☐Current healthcare provider CPR. Include a color photocopy of both front and back of card. If e-cards are issued, send a copy with all information necessary for our office to verify the course. *Certification must be one of the following:

☐ American Heart Association: Basic Life Support (BLS) for the Healthcare Provider

☐ Red Cross: Basic Life Support for Health Care Providers

☐ National Safety Council: Basic Life Support for Health Care and Professional Rescuers

* Be very cautious of courses that make claims of equivalency or pretend to be one of the above organizations. We will not accept any substitute for one of the three approved courses. Links to the correct websites is provided on the ATM website

☐ Student portion of module 1 tuition (15% of the normal tuition per module.)

☐Must be a student member of the Association of Texas Midwives (ATM)

Not every person is well-suited for the demands of midwifery. Take note of the following statements:

Qualities and Requirements of the Midwifery Student

Midwifery is a physically, emotionally, and psychologically demanding profession.

You must have sufficient use of all cognitive, sensory and motor abilities to properly evaluate and care for mothers and babies. This includes, but is not limited to:

  • Good interpersonal skills; being able to develop rapport and positive interactions with clients, midwives, and other care providers
  • Able to learn to conduct basic office lab procedures
  • Learn to perform clinical care activities such as palpation, auscultation, percussion and evaluation of physical findings
  • Analyze and synthesize information to problem solve and reach diagnostic and therapeutic judgments
  • Communicate with accuracy, clarity and sensitivity both verbally and in writing
  • Learn to respond to emergency situations with quick and appropriate actions
  • Be able toreceive and acknowledge evaluation and respond appropriately

Is This the Right Time in Your Life to Begin Midwifery School?

All applicants must read and sign the “Readiness-Commitment Survey”. A copy is included at the end of this application packet. It must be signed andsubmitted with the scholarship application packet.

INSTRUCTIONS

Download this form and save the form to your computer, including your last name as the first word of the file name(IE, “Smith Preliminary Application”.) Reopen the file from the folder to which you have saved it, and then complete all sections on your computer by “clicking” on the appropriate check box and typing answers in the shaded areas.Please note that the Education Committee evaluates not only the content of your answers, but also grammar, spelling, writing ability, and your ability to follow instructions.Proof-read your work!Save your completed application, and then:

  1. Email the completed form as a Word document attachmentto the ATM Course Coordinator at . Do not mail your application.
  2. The signature page of the “Readiness” survey may be emailed as either a PDF or image (jpeg/jpg/png/gif) but all documents must be attached to the same email.
  3. The subject line of the email must contain your last name and “preliminary scholarship application”.

Your application will not be considered if you do not provide proof of meeting the minimum educational standards. Copies of high school, college, or home school transcripts, or a GED certificate with exam scores are required. Diplomas are not accepted.Transcripts must beemailed or mailed to the address on page one. If mailed they must be postmarked no later than August 31st, and received in our office no later than September 10th.

You will receive a confirmatory email that your application has been received.

If you have questions regarding the application process contact the Course Coordinator by phone at 432-664-8845 or by email to .

NO APPLICATIONS WILL BE ACCEPTED AFTER AUGUST 31st.

ATMMTP Scholarship Application Page 1 of 17 Rev. 2017-6

Scholarship Application Form

Section 1: Personal and Demographic Data

Full legal name: / Date:
Maiden name: / Other names used:
Address:
City: / State: / Zip:
E-mail address:
Phone:
Cell: / Home: / Driver’s Lic #: / State:
Date of birth: / Age: / ☐I am already a member of ATM
Section 2: Background Information
1. Complete the following, as applicable:
☐ High school ☐ Home school ☐ GED Year graduated:
☐ SAT: Year Composite score:
☐ ACT: Year Composite Score: Writing Skills Score:
☐ College (all core courses completed): Year: Hours: GPA:
☐ Degree: Year completed:
2. Do you have training/certification/licensure in any of the following? For each item checked indicate if you graduated or received certification, or if you did not complete the course:
☐Doula ☐Childbirth Education
☐LVN/LPN ☐RN ☐EMT/Paramedic
☐Lactation/Breastfeeding Consultant ☐CNA
3. Have you taken courses, received training, or done volunteer work not included in the above answer? If yes, briefly describe:
4. Marital status: ☐Single ☐Married ☐Separated ☐Divorced
5. Are you living at home with your parents? ☐No ☐Yes
→ If yes, are you financial dependent on them? ☐No ☐Yes
6. Do you have any children? ☐No ☐Yes
→ If yes, what are their ages:
7. Are you involved in any activities that take a large amount of your time? ☐No ☐Yes
→ If yes, please explain how you intend to integrate your midwifery training into your schedule:
8. Are you employed? ☐No ☐Yes
→ If yes, please give the name of the company you work for and your position:
→ If yes, please indicate if full or part time and how many hours per week you must work:
→ If yes, is your employment flexible enough to allow for time off at will?
→ If yes, does your employer understand the unpredictable nature of birth?
→ If yes, is your family financially dependent on the income from your employment?
9. Are you still in school? ☐No ☐Yes
→ If yes, what is your time commitment?
→ If yes, when you graduate?
10. Study time, completing assignments, and attending workshops will be a timeconsuming process. Clinical training can involve long and frequently unpredictable hours away from home. How do you plan to care for your family, including childcare,and meet your work responsibilities as you train formidwifery? →
11. Do you know a midwife with whom youcanapprentice? Is she an ATM preceptor? How far away from you isthe closest midwife? What are her qualifications? If there is not a preceptor near you are you able to travel in order to obtain meet your clinical requirements?
Section 3: Beliefs, Values, and Intent
1. What is your philosophy of childbirth?
2. What was your first introduction to midwifery?
3. What one quality or requirement stated in the “Qualities and Requirements of the Midwifery Student” do you believe is your greatest strength and why?
4. What one quality or requirement stated in the “Qualities and Requirements of the Midwifery Student” do you believe is your weakest area and why?Please do not select performing lab procedures or clinical skills, since these skills are learned during the program.
5. Name one book about midwifery or childbirth that you have read and relate to, or especially enjoyed, and why.
7. After licensure, what are your plans? Do you plan to have a solo midwifery practice, work in or own a birth center, work in a mission field, etc.?
10. Why did you select the ATM Midwifery Training Program as your pathway to midwifery education?

ATMMTP Scholarship Application Page 1 of 17 Rev. 2017-6

Name:

Section5: Financial information

What is your personalgross income? $ per ☐week ☐month
What is you total monthly family gross income? $
What is you total monthly family net (take-home) income? $
What is the monthly cost of the following expenses: / Amount
Rent/mortgage
Utilities (electric, gas, water)
Phone/internet service
Car payment(s)
Insurance (auto, medical, etc.)
Current credit card debt: $ Monthly payment:
Groceries
Child Care
Other monthly expenses (cable, gasoline, loans, etc.):
TOTAL MONTHLY EXPENSES (subject to verification)

ATMMTP Scholarship Application Page 1 of 17 Rev. 2017-6

Name:

Section6: Essay – Why I want to be a midwife

Instructions: Write a short essay telling us why you want to be a midwife. The essay must be no more than approximately 300 – 600 words.

Section 7:Tell us about your own childbirth history OR (if you have had no children of your own) any experience you have had with childbirth.

You have completed your application. Don’t forget to “save” your work prior to closing and attaching to the email!Beginning in the next section is information about the “Midwifery Model of Care” essay that will be a part of phase 2 of the application process. Following that is the “Readiness-Commitment Survey”; it must be returned with the application.

Email to:

ATMMTP Scholarship Application Page 1 of 17 Rev. 2017-6

Applicant Midwifery Model of Care Essay

Instructions and Criteria

Introduction

Distance education is not always the best method of learning for some students. To be successful in a distance program, the student must have good reading comprehension skills, the ability to follow written instructions, and the ability to communicate in writing that the student has learned the material. In addition, midwives must be able to effectively communicate in writing in their professional practice. The profession involves a great deal of written communication with clients, in medical charts, and with other healthcare professionals.

As part of the acceptance process for enrollment into the ATM Midwifery Training Program, applicants must write an essay on the components of the Midwifery Model of Care. The essay will be evaluated by at least three ATMMTP staff members using the criteria given in these instructions.

The general criteria on which the essay will be evaluated are:

  • content
  • writing skills
  • the ability to follow all instructions

Essay Criteria

The following information includes what we are looking for in the essay content, and specific instructions on the presentation of the essay. Suggested resources are given at the end of these instructions.

The essay will consist of three sections:

  1. Title page
  2. Body of the paper
  3. Reference page

The paper must be written using a modified APA format. A brief presentation on using the modified APA will be available in our online learning management prior to the submission. The applicant will have access to the presentation for 10 days before the essay submission is due. There are many online resources for using APA; however, we will expect our modified version to be used.

Title Page

The title page of the essay will consist of all the following, using a bullet point list, in this order:

  • applicant's full name
  • address
  • phone number
  • email address
  • class start date (class for which the applicant is applying)

The body of the paper will begin on the next page.

Body of Paper

The body of the essay must be 900 - 1600 words and double-spaced. It must be typed in a 12 point sans-serif font, with 1 inch margins. Acceptable fonts are Arial or Verdana. The document must be written in and submitted in Microsoft Word.

The Content

The applicant needs to demonstrate that she understands the components that have come to be known as the Midwifery Model of Care. She will do this by identifying a minimum of 7 components, with discussion and examples, as appropriate. Examples may be from resources or personal experience.

The essay sources of information must be properly cited, and a separate reference list included.

Writing Skills

Applicant’s writing skills will be evaluated as follows:

  1. "Readability"
  2. The ease with which the content of the essay can be read and understood. Includes organization of thoughts and clarity of writing. There should be an appropriate amount of information that is "on topic", without extraneous information that detracts from the content. If medical terminology is used, it should be used correctly.
  3. Spelling
  4. Use of APA style for citing sources and reference list.

The ease with which the content of the essay can be read and understood. Includes organization of thoughts and clarity of writing. There should be an appropriate amount of information that is "on topic", without extraneous information that detracts from the content. If medical terminology is used, it should be used correctly

Following Instructions

Every essay assessment will include the ability of the applicant to read and follow written instructions. The applicant will be expected to interpret these instructions and criteria without additional input. This means that the applicant is expected to “figure it out” on her own, without contacting the school for additional instructions.

Recommended Resources

The applicant may use sources other than those given below; however, we recommend that the information on the Citizens for Midwifery website form the foundation of the essay.

  1. Citizens for Midwifery
  2. MANA Statement of Values and Ethics (
  3. Davis, Elizabeth. (2012) Heart and Hands: A Midwife’s Guide to Pregnancy and Birth, 5th edition, Ten Speed Press

ATMMTP Scholarship Application Page 1 of 17 Rev. 2017-6

Readiness-Commitment Survey

Is This the Right Time in Your Life to Begin Midwifery School?

Instructions: Read the following questions carefully. Think about them. You do not need to provide written answers, but you should honestly answer them for yourself. We suggest going over the questions with your partner or other family members also, if applicable. If, after careful consideration, you decide that this is the appropriate time in your life to begin your midwifery education, and you feel able to commit the next approximately 3 or more years to your education, fill in the requested information on the last page and submit a copy with your application.

Family

Do you have children?

  1. You get a call at 3:00am that a client is in active labor with contractions 3 minutes apart. She was only in labor for 2 hours with her previous baby and she lives 45 minutes from your home. You need to be out of your door in 10 minutes. Who is going to care for your children?
  2. You get a call at 3:00am that a client is in active labor with contractions 3 minutes apart. She was only in labor for 2 hours with her previous baby and she lives 45 minutes from your home. You need to be out of your door in 10 minutes. Your husband is out of town. Who is going to care for your children?
  3. You are with a laboring client; you can’t leave her. Your children have to be picked up from school in an hour. What will you do?
  4. You have a 2 month old baby when you begin your apprenticeship. You are sure that you can pump breastmilk for your sitter to feed him. After 3 weeks you realize your milk supply is drying up. What will you do?
  5. It is your 5 year old’s birthday and her party is this afternoon. Your preceptor calls and says that a client’s membranes just ruptured and you need to come to the birth center. Explain to your child that you will not be there for her party.
  6. You have had 3 births in the past 5 days and have been home for only about 2 hours. You’ve just been called in to the birth center - again. Your children overhear the phone conversation and start crying. What will you say to them?
  7. It is Christmas Eve and you have a special family gathering planned in your home. A client who is not due for another 4 weeks calls and reports signs of premature labor. What will you do?
  8. You are at a birth and your babysitter calls and says she has run out of the pumped breastmilk you provided to feed your baby. What will you do?
  9. You’ve had prenatal exams 1 day this week, and two unexpected, back-to-back births. You have had a total of 4 hours sleep in the past 48 hours. You must leave in the morning to attend the 3 day mandatory workshop and haven’t finished your final assignment, due in 16 hours. Your husband planned a surprise dinner out for you and the kids. How will you keep your family happy, take care of your assignment, and get the sleep you need?
  10. Your children received their school grades and your 14 year old has several failing grades. You had no idea he was not been doing his homework and missed an exam. You realize you missed the parent-teacher conference last week due to a birth. What are you going to do?
  11. Your sitter just texted you a lovely picture of your baby, sitting up for the first time by herself! Yea! But you missed it, and may miss her first step, or her first word. Are you prepared for this?

Are you employed?