**Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.**
1.
Do you possess a bachelor’s degree from an accredited college or university in nursing, social work, psychology, education or counseling?
Yes
No
2.
If you do not possess a bachelor's degree from an accredited college or university in nursing, social work, psychology, education or counseling, in what field is your degree?
Please be sure to attach an unofficial copy of your transcripts to substantiate all college course work and to document all related experience on your resume.
3.
Do you possess a license as an International Board Certified Lactation Consultant (IBCLC)?
Yes
No
4.
If you answered "yes" to the previous question, please submit a copy of your IBCLC license with your application. You may also indicate your certification number and expiration date below.
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