NEW VOLUNTEER APPLICATION: Midwives For Haiti

Contact Information

Birth Date*
Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*
Sometimes MFH likes to use volunteer names, quotes, images, or other materials to support our work and tell our story across various media channels.... Check here if you agree.*
  • Yes, I grant MFH permission.
  • No, I do not grant MFH permission.

Volunteer Information

Midwives For Haiti volunteers are responsible to precept students at low-resource prenatal clinics in remote villages, as well as at birth centers and hospitals, where emergency medications and transportation may not always be available. In some cases babies and women could and do die from those lack of resources. If you feel these situations potentially too overwhelming for you, a trip with Midwives for Haiti is likely NOT for you.*
  • Yes, I understand the above and want to continue with my application.
  • Yes, I further understand that I will not be able to do any of the following: publish photos, videos, blogs on any social media or public forum without permission from Midwives For Haiti Board.
Desired trip departure date SATURDAYS ONLY (1st choice) **mm/dd/yyyy*
Desired trip departure date SATURDAYS ONLY (2nd choice) *mm/dd/yyy**
Desired trip length*
  • 1 week
  • 2 weeks
  • 3 weeks
  • 4 weeks
  • More than 4 weeks
Previous Midwives For Haiti Experience?*
Professional Credentials*
  • RN - LD
  • Certified Nurse Midwife
  • Certified Professional Midwife
  • OB-GYN
  • Registered Midwife
  • Licensed Midwife
  • Women's Health NP
  • Pediatric NP
  • RN
  • Family NP
  • Student
  • Non-medical
Training and/or Experience*
  • High-risk obstetrics
  • Teaching
  • Labor and delivery nursing
  • Primary care for women as a nurse, NP, CM, or CNM
  • Lactation training skills
  • None of the Above
Advanced Midwifery Skills*
  • Vacuum-assisted vaginal deliveries
  • Norplant insertion
  • IUD insertion
  • Newborn resuscitation
  • None of the Above
Place/Setting of training/experience*
  • Birth Center
  • Home birth
  • Hospital Birth
  • Medical experience in developing countries
  • Other
  • Not Applicable
Language Skills*
  • Proficiency in French
  • Proficiency in Creole
  • Fluency in French
  • Fluency in Creole
  • None of the Above
If you have a background in international development, NGO management, curriculum design, data analysis, public health, or other skills that would benefit either the staff at MFH or the programs, please feel free to list these skills.
Other Skills?*
If applicable, please describe the scope of your current medical practice.*
Do you have any experience in a developing country or a cross-cultural setting? If yes, please describe:*
Please list below any activities or projects that you are interested in leading or participating in:*
Emergency Contact Name (First and Last)*
Emergency Contact 10-digit Phone Number (0000000000 format, no dashes)*
When would you be available for an interview?*
Do you have any dietary preferences?*
  • None
  • Vegetarian
  • Other (Please include details in ADDITIONAL COMMENTS section below)
  • Vegan
  • Gluten Free
  • Dairy Free
T-Shirt Size*
  • S
  • M
  • L
  • XL
  • XXL
  • None of the Above
How did you learn about MFH?*
  • Facebook
  • Website/Online Search
  • Referred by another MFH Volunteer
  • Other
  • ACNM Meeting & Exhibition
  • ACNM E-Newsletter
If you were referred by another MFH volunteer, please list their name. If not, please write N/A.*
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