Fillable Continuing Education Contact Hours Live Webinar Application Form

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Continuing Education Contact Hours Live Webinar Application Form

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Continuing Education Contact Hours
Live Webinar Application Form
Last Revised: 07/21
BOD Revision Approval:07/21
BOD Revision Approval: 06/20
BOD Original Approval: 03/15
D
ear Applicant,
Thank you for your interest in applying for DONA International continuing education contact hours. It’s because
of quality and enriching continuing education materials that our doulas can remain proficient in the profession
and have a spirit of always learning, always growing.
Attached you will find the application for contact hours for live webinar courses/workshops. If you intend to
offer in-person courses/workshops or recordings of your course content, please use the applications specific to
those formats. If you have any questions about submitting an application or discussing what would make for a
quality submission, please contact ContinuingEdApps@DONA.org.
Submission of an application does not guarantee acceptance of the course/workshop for contact hours. The
$20 for members/$30 for non-members application fee is non-refundable. If approved, the contact hour fee of
$10 for members/$25 for non-members per contact hour will be due upon receipt of approval. DONA
International will only approve a maximum of 14 contact hours per course/workshop.
We truly appreciate your contribution to the advancement and education to certified doulas around the globe.
Together, our passion for families touches the world.
In the DONA doula spirit,
DONA International
Continuing Education Contact Hours
Recorded Course Application Form
Last Revised: 07/21
BOD Revision Approval:07/21
BOD Revision Approval: 06/20
BOD Original Approval: 03/15
Continuing Education and the Doula’s Scope of Practice
A doula provides continuous physical, emotional, and informational support to the mother before,
during, and after childbirth.
It is the position of the DONA International Education Committee to approve continuing education offerings that
may teach techniques that may not fall within the DONA International doula’s Scope of Practice. We believe
that doulas should have the opportunity to broaden their horizons and learn about other aspects of the
childbearing year. But the knowledge of these techniques does
not change the doula’s scope of practice.
Just as doulas know about the process of a cesarean birth, the doula does not perform the surgery but
supports the emotional and physical needs of the woman before, during and after the cesarean birth. Since not
all issues are as black and white as this example, the following list of questions can be used to help a doula
assess whether the doula’s action or advice is outside or within the doula’s scope of practice.
Ask yourself the following questions about the action or advice:
1. Are there claims of specific medicinal or healing benefits from the “remedy” (as opposed to
soothing a normal pregnancy or labor discomfort) or claims to correct or cure an abnormality?
2. Are there any possible harmful side-effects?
3. Does the action or advice on this subject require special training, certification, or extra education
to ensure safety and proper application?
4. Does the remedy usually require a prescription or supervision of a trained clinician?
5. Is the subject for which you are giving advice usually covered by a doctor, midwife, or maternity
nurse?
6. Might your advice conflict with that of your client’s clinical care provider?
7. Might your action or advice worsen the relationship between your client and her caregiver?
If the answers to all the above questions are “No,” then the action or advice is probably acceptable within the
doula’s scope of practice. If the answer to one or more question is “Yes,” then you should not do it.
Continuing Education Contact Hours
Recorded Course Application Form
Last Revised: 07/21
BOD Revision Approval:07/21
BOD Revision Approval: 06/20
BOD Original Approval: 03/15
Continuing Education Approval Guidelines
What qualifies for DONA International Continuing Education hours?
The Education Committee will approve only educational events (presentations and workshops) on topics that
are not typically covered in the DONA International birth or postpartum introductory workshops. These topics
must provide continuing education on topics relevant to the scope and practice of doulas. Some acceptable
examples of continuing education topics would be:
Adoption and the Doula
Induction and Augmentation of Labor
Advanced Breastfeeding Support
Special Needs Clients
Multicultural Issues
Advanced Comfort Measures
Postpartum Disorders
Sharing Case Studies
Grief and Loss
Birth Plans
Difficult Labor Scenarios
Socially Disadvantaged Client
Medical Interventions
Cesarean/VBAC
Course content must be appropriate for distance learning. Techniques that are best learned “hands on”, such
as massage, acupressure, or rebozo work, will not be approved
for live or recorded webinar contact hours.
Instructors and facilitators should make every effort to reflect the values of DONA International by using
inclusive language, being culturally aware and sensitive, and representing the diversity of birthing and
postpartum people and families in their course content.
It is NOT necessary to apply for DONA International CE hours if a program already has CE hours in place from
another major perinatal organization such as ICEA, Lamaze International, IBLCE, and all nursing organizations.
No applications will be approved if the scheduled date will take place within 6 weeks and 150 miles an official
DONA International function, for example a DONA International Summit, sponsored doula workshop, or
Regional Member Meeting.
After approval, DONA International will provide a link to the course evaluation. Attendees will receive a
Certificate of Attendance with a record of their contact hours after they have completed their evaluation.
DONA International will provide a free listing for the first instance of a DONA-approved training on the DONA
website. Additional listings can be purchased for $25 per date.
Continuing Education Contact Hours
Live Webinar Application Form
Last Revised: 07/21
BOD Revision Approval:07/21
BOD Revision Approval: 06/20
BOD Original Approval: 03/15
Applications will take at least six (6) weeks to move through the committee. Please plan accordingly and
submit your application in a timely manner.
PLEASE NOTE: No applications will be approved if the scheduled date will take place within 6 weeks and 150
miles an official DONA International function, for example a DONA International Summit, sponsored doula
workshop, or Regional Member Meeting.
Name of Course/Workshop
Is this application a renewal?
Date of the Event
Previous approval code, if applying for renewal
Event Location
# of contact hours requested (14 maximum)
Name of Instructor
Name of Sponsoring Organization (if applicable)
Name of Contact Person
Mailing Address of Contact Person
Email Address
Website
Daytime Phone
Mobile Phone
Describe the target audience for this event:
All DONA International approved Continuing Education programs will be listed free of charge for the first scheduled date
of the course. Additional listings can be purchased for $25 per date.
Continuing Education Contact Hours Processing Fees
and DONA Website Listing
Last Revised: 07/21
BOD Revision Approval:07/21
BOD Revision Approval: 06/20
BOD Original Approval: 03/15
Application Checklist
Submit the application materials by email in the following order:
q Application Form and this completed Checklist
q Copies brochures and advertising documents, including any proposed email or social media advertising. Online
invitations in any form should be tasteful, accurate and must not use DONA International's name as an endorsement
of the substantive content. A reference
to DONA International's contact hours being available is permitted.
q Overall program format (agenda with specified time lengths for each topic)
q Objectives for each topic
q Outline for each topic
q Teaching methods and materials for each topic
Describe the teaching methods to be used (discussion, lecture, demonstration, etc.) and what materials, includi
ng
audiovisuals and handouts, will be used.
q Twenty (20) minutes of quality recorded footage of the proposed online course or workshop, with the facilitator
teaching specific content from the webinar. Webinars should be recorded with a high-quality camera and
microphone in a professional setting to ensure top-quality education.
q The name of the hosting platform/vendor
q A quiz for each webinar (if multiple parts) with questions pertaining to the content that will be given to participants
prior to a certificate to ensure successful completion of the course, along with details on the quiz method
q Options available for social interaction and engagement of students (i.e. social media, private Facebook group,
Google hangouts, live chats, etc.)
q Complete bibliography for each topic
The majority of references must be within the last five (5) years. Use formal bibliography formatting (MLA, APA,
Chicago, etc.). Website articles maybe be used, but general site urls will not be accepted, e.g. “kellymom.com”.
q Resumé(s) of all instructors/speakers/facilitators demonstrating qualifications, training, experience and expertise in
the subject
q Means to determine attendance of entire event by participants
q The $20 for members/$30 for non-members application fee is non-refundable. If approved, the contact hour fee
of $10 for members/$25 for non-members per contact hour will be due upon receipt of approval.
q Signed Webinar Facilitation Agreement
q Total number of pages submitted, including the Application and this Checklist: ________
Approval for web-based continuing education will last for a two (2) year period.
PLEASE NOTE: DONA International approves live online offerings that are webinar-based and interactive with
students/attendees. You must ensure that students/attendees have their cameras on and remain engaged to receive
contact hours. If you have a question about whether or not your continuing education curriculum meets this criterion,
please email ContinuingEdApps@DONA.org.
Last Revised: 07/21
BOD Revision Approval:07/21
BOD Revision Approval: 06/20
BOD Original Approval: 03/15
Continuing Education Contact Hours
Application and Processing Fees:
$20.00 USD for members/$30.00 USD for non-members application fee. Pay appl
ication fee by going to the
DONA Boutique - click on DONA Membership and Certification - click on Certification Applications,
Extensions, Renewals - click on General Merchandise. Follow the instructions for making a purchase.
Final Fees:
Upon approval, fees for contact hours will be due at the rate of $10 per contact hour for members/$25 per
contact hour for non-members.
To calculate DONA International Continuing Education Contact Hours
1. Add up the total number of minutes of instruction
a DO NOT include breaks
b DO NOT include any homework or assignment time that is required outside workshop/webinar
time.
2. Divide the total minutes of instruction by sixty (60). (60 minutes of instruction = one (1) DONA
International Continuing Education Contact Hour)
Total number of DONA International Continuing Education hours requested: _
To pay for the open invoice you will want to follow the instructions in the Invoice section of the Member
Portal and click See All Invoices. The next page will bring you here and you will want to click "Add to
Shopping Cart". The next page will summarize your shopping cart and if you have all items you want to
process please click Checkout. This will bring you to the payment page.
Continuing Education Contact Hours Processing Fees
and DONA Website Listing
Agreement
I, __________________________, am requesting DONA International contact hour approval for the
(Name of Applicant)
following continuing education course:
_____________________________.
(Title of Webinar/Course)
I understand that my approval is contingent upon the following agreement:
q I agree to provide objectives, evaluation, and refer in print or link to DONA International Code of Ethics
Standards of Practice.
q I agree to provide participants with a webinar of high quality, meeting professional standards in audio and
visual recording.
q I agree to present a course/workshop which is interactive with students/attendees and will ensure that
students/attendees have their cameras on and remain engaged to receive contact hours.
q I agree to provide the participants with a link to the course evaluation ONLY AFTER confirming they have
completed the quiz(zes) and verifying their engagement.
q I agree to provide contact hours for webinar time ONLY and not for additional assignments or homework.
q I agree to use the certificate created by DONA International, which students/attendees will receive only
after completing the course evaluation
.
q I agree to provide DONA International with the names, mailing addresses, email addresses, evaluations,
and quizzes of the participants, or a report stating that there were no participants, once every quarter
during my approval period.
q All of the information I have provided is accurate and I have not omitted any information material to DONA
International's evaluation of my application.
q I agree to provide DONA International a singular code for a member of the Education Committee to
observe the course in its entirety.
I understand that failure to abide by this agreement and provide all necessary documentation could lead to
revocation of my contact hour approval and jeopardizes future approvals.
Signature:
Last Revised: 07/21
BOD Revision Approval:07/21
BOD Revision Approval: 06/20
BOD Original Approval: 03/15
Date: ____________
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Continuing Education Contact Hours
Last Revised: 07/21
BOD Revision Approval:07/21
BOD Revision Approval: 06/20
BOD Original Approval: 03/15
Marketing Agreement
I, , am requesting DONA International contact hour approval for the
(Name of Applicant)
following continuing education course:
_____________________________.
(Title of Webinar/Course)
I understand that my approval is contingent upon the following agreement:
q I agree that the initial marketing materials related to this webinar-based course that are sent/shared with
consumers must be pre-approved by DONA International. All information in future ads must be consistent
information
.
q For webinar-based course only: I agree that ads to online courses link directly to the webinar-based
course described above only, and a link from the sales page to the DONA International website is
present.
q I agree to use “DONA International” and not use “DONA” (or a variation) in written marketing materials.
q I agree not to use the DONA International logo on any product or materials. I understand I do not have
DONA International logo usage rights/privileges (unless you are a DONA International approved trainer).
q I agree not to spam anyone with information for the workshop/webinar-based course.
q I agree to not misuse the DONA International doula listing/directory on the DONA International website.
q I agree not to imply or tell consumers that DONA International endorses any product or guarantees any
results
.
q I affirm that I am not using this webinar-based course in relation to any other business opportunity or
referral-based compensation scheme or industry, but not limited to multi-level marketing programs o
r
unauthorized products (not approved by DONA International)
q All of the information I have provided is accurate and I have not omitted any information material to DONA
International's evaluation of my application
I understand that failure to abide by this agreement and provide all necessary documentation could lead to
revocation of my contact hour approval and jeopardizes future approvals.
Signature: Date:
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Continuing Education Contact Hours Live Webinar Application Form

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Completed 7 January 2022

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