
	Hello Birthwise Students! It is that time of year again! Please take the moment to register for your FALL 2021 courses through the Sycamore system. Below you will find instructions. REGISTRATIONS MUST BE COMPLETE BY MAY 20TH. YOU MAY NOT REGISTER FOR PRECEPTORSHIP CREDITS UNTIL YOU HAVE SUBMITTED YOUR PRECEPTORSHIP CREDIT WORKSHEET TO THE CLINICAL DIRECTOR. Step 1: Login in using your Sycamore credentials. Step 2: Review and update your contact information. Hit next at the bottom, left-hand corner. Step 3: You will then be asked to update additional student information. Step 4: On the next window press the + sign to the left of the title "Midwifery Program." A list of the upcoming semester’s courses will display. Check off the courses you need to take for Fall Semester 2021. Press the + sign next to the title Clinical Program for Preceptorship credit options. You will be able to register for the amount of preceptorship credits that Clinical Director Sarah Schubeck has approved. YOU MAY NOT REGISTER FOR PRECEPTORSHIP CREDITS UNLESS YOUR PRECEPTORSHIP CREDIT WORKSHEET HAS BEEN SUBMITTED TO THE CLINICAL DIRECTOR. PLEASE CONTACT US WITH ANY QUESTIONS registrar@birthwisemidwifery.edu

Student Information Continued

Prior Education

Type of Secondary Education:
	What type of high school education do you have?
Name of High School:
	Documentation of high school completion is required.
Date of Graduation:
	Date of graduation must be on official transcripts.
Highest Degree Earned :

Degree Earned 1 (if applicable):
	Degree & major eg: BA Art History. Type N/A if none.
Date of Graduation:
	mm/dd/yy. Type in N/A if none.
Degree Granting Institution:
	Name of institution attended. Type in N/A if none.
Institution Location:
	City, State/Region. Type in N/A if none.
Degree Earned 2 (if applicable):
	Degree & major eg: BA Art History. Type N/A if none.
Date of Graduation:
	mm/dd/yy. Type in NA if none.
Degree Granting Institution:
	Name of institution attended. Type in NA if none.
Institution Location:
	City, State. Type N/A if none.
Other Certification/Courses:
	Relevant (Non-degree) Educational Experience - or N/A
Other Certification/Course Dates:
	Dates of other educational experience/s. N/A if none.
Other Educational Institution:
	Name/type of institution attended. Type N/A if none.
Other Education Location:
	City, State/Region. Type N/A if none.

Application

How did you hear of Birthwise?:

Name of Birthwise referral :
	Is there someone we can thank for referring you to us?
Program Options:

Providing Letter of Reference 1:
	Reference provider: Name, Relationship and Contact Info
Providing Letter of Reference 2:
	Reference provider: Name, Relationship and Contact Info
Providing Letter of Reference 3:
	Reference provider: Name, Relationship and Contact Info
Mentor Midwife/Preceptor :
	Name of the midwife you work with (or plan to)
Preceptor Location:
	Clinic name (if applicable), City, and State

Prior Experience

Number of Prior Births:
	How many births have you attended (if any)?
Prior Births: Your Role?:
	Were you acting as Doula, Assistant, Primary or other?
Prior Relevant Experience 1:
	Prior experience relevant to training as a midwife
Prior Experience Date(s):
	mm/dd/yy or mm/dd/yy - mm/dd/yy
Contact Person (if applicable):
	Name, email address, phone number
Prior Experience Description:

Prior Relevant Experience 2:
	Prior experience relevant to training as a midwife
Prior Experience Date(s):
	mm/dd/yy or mm/dd/yy - mm/dd/yy
Contact Person (if applicable):
	Name, email address, phone number
Prior Experience Description:

Prior Relevant Experience 3:
	Prior experience relevant to training as a midwife
Prior Experience Date(s):
	mm/dd/yy or mm/dd/yy - mm/dd/yy
Contact Person (if applicable):
	Name, email address, phone number
Prior Experience Description:

Financial

Financial Aid Interest:
	Do you plan to apply for financial aid?
Title IV Loans and Grants:
	I am interested in applying for Title IV funding
I completed a FAFSA:

Birthwise Scholarships:
	I plan to apply for the
External Scholarships:
	I will be using other scholarship money
Canadian and International Funds:
	I plan to pay with OSAP funds (Ontario residents only)

Demographics

First three of Social Security #:
	Please provide the first 3 digits of your SSN
U.S. Student Visa:
	Do you require a student visa?
Full Permanent Address:
	Street, City, State/Province, Zip/Postal Code
Preferred Email Address:
	An email address you check daily.
Family Status:
	OPTIONAL has no bearing on your application.
Family Names & Ages:
	OPTIONAL has no bearing on your application.
Primary Language:
	OPTIONAL has no bearing on your application.
Other Language(s):
	OPTIONAL has no bearing on your application.
Personal Pronouns:
	What pronouns do you use? (ex. she/her, they/them)
Race/Ethnicity per Dept of Ed:
	Does not affect admissions or financial aid application
Hispanic/Latinx?:
	Do you identify as Hispanic/Latinx?

Emergency Contact

Contact Name:
Contact #:


	Thank you for using our electronic registration system! PLEASE CONTACT US WITH ANY QUESTIONS registrar@birthwisemidwifery.edu