Experienced Teaching Documentation

Complete the following form to document 24 months of teaching experience. It is not necessary to complete 2 & 3 on the form if the first location you taught shows the required 2 years.

Verification Form

Email Address *

First Name and Last Name *

Phone Number *

How long have you taught childbirth classes *

1. Where did you teach classes - Name of place, city and state *

From date to date *

Name & title of person to verify your teaching history *

Their phone number *

Their email address *

2. Where did you teach classes - Name of place, city and state

From date to date

Name & title of person to verify your teaching history

Their email address

Their phone number

3. Where did you teach classes - Name of place, city and state

From date to date

Name & title of person to verify your teaching history

Their email address

Their phone number