Recertification RequestName* First Last Address* Street Address Suite, Apt, or Unit # City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Please use the email associated with your initial registration for the SMC Full Circle Doula Birth Companion Training.Phone*Proof of CertificationUpload a copy of your most recent SMC Certified Doula Certificate*Accepted file types: png, jpg, pdf, Max. file size: 256 MB.Re-Certification DocumentationContact Hours*OrganizationCourse/ProgramContact Hours 18 Contact Hours are required. Online, hybrid and in-person courses/programs are eligible. Note: Click the + symbol to add a new rowTotal Contact HoursPlease enter a number from 1 to 18.Enter the total amount of contact hours earned.Upload documentation for each course/program*i.e: Certificate of Completion Drop files here or Select filesAccepted file types: pdf, jpg, png, Max. file size: 256 MB. Fee* Price: Total $0.00 Δ
