Recertification ApplicationRecertification Request First Name * Last Name * Address * Address Street Address Street Address Suite, Apt, or Unit # Suite, Apt, or Unit # City City State / Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State / Province ZIP / Postal Code ZIP / Postal Code Email * Please use the email associated with your initial registration for the SMC Full Circle Doula Birth Companion Training. Phone * Proof of Certification Upload a copy of your most recent SMC Certified Doula Certificate * Drop a file here or click to upload Choose FileMaximum file size: 268.44MBRe-Certification DocumentationContact Hours18 Contact Hours are required. Online, hybrid and in-person courses/programs are eligible. Note: Click the + symbol to add a new row Organization Course/Program Contact Hours plus1 Add minus1 Remove Total Contact Hours Enter the total amount of contact hours earned. Upload documentation for each course/program * Drop a file here or click to upload Choose FileMaximum file size: 268.44MBi.e: Certificate of Completion3-Year SMC Certified Doula Recertification * Fee: $200.00 Total Payment Information If you are human, leave this field blank. SubmitΔ
