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Birth Strides Community Perinatal Health Worker Application
Indicates required field
38106 (South Memphis)
38107 (North Memphis)
38108 (North Memphis)
38111 (Orange Mound)
38114 (Orange Mound/ Glenview)
Applicants must live within one of neighborhoods served.
Are you currently employed?
No, I'm a student
No, I'm unemployed
If currently employed, please list your occupation
Some High School
Completed High School
Total household Income
Do you have children?
Yes, 3 or more
What is your availability to work with clients post training?
4-6 hours per week
6-10 hours per week
10-12 hours per week
12-15 hours per week
15 + hours per week
Do you have the ability to be on call for births and provide continuous support for an indeterminable time period?
Are you able to attend 1-2 births per month
Do you have prior birth experience?
Yes, I have attended at least one birth other than my own
Yes, I have experienced childbirth
No, I have no prior birth experience
Do you have home visitation and/or case management experience?
Yes, I have case management experience
Yes, I have home visitation experience
Yes, I have home visitation and case management experience
No, I do not have experience in home visitation or case management
Are you a currently trained birth worker? (Check all that apply)
If applicable, please list any health related trainings, degrees, or certifications and dates completed
What are your goals for becoming a Community Perinatal Health Worker?
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