Board of Certified Direct-Entry Midwives

Applications & Forms

Initial Applications

• Application for Certification as a Direct-Entry midwife by Examination
  #08-4215, Revised 01/26/2017
• Application for Certification as a Direct-Entry Midwife by Credentials
  #08-4198, Revised 01/26/2017
• Application for Permit as a Direct-Entry Midwife Apprentice
  #08-4228, Revised 07/24/2020
• Application for Direct-Entry Midwife Apprentice Preceptor
  #08-4240, Revised 11/29/2012
• Emergency Transport/Incident Report
  #08-4551, Revised 09/01/2010

Renewal Applications

Renewal applications will be available no later than March 1, 2023, in accordance with AS 08.01.050. Please note, you must wait for an updated renewal application to renew your license. You cannot renew your license using any prior renewal forms. If you need to renew your license for the current licensing period (1/1/2021 – 03/31/2023), email Midwives@Alaska.Gov to request the appropriate form. To ensure receipt of renewal notifications and other correspondence from our office, please go to MY LICENSE and confirm your current mailing address is on file.

Miscellaneous Forms

• Request for Examination Review
  #08-4725, Revised 09/20/2022