Board of Certified Direct-Entry Midwives

Applications & Forms

Initial Applications

• Procedures for Obtaining Certification By Examination as a Direct-Entry Midwife
  #08-4215, Revised 01/26/17. Application for certification by examination.
• Procedures for Obtaining Certification By Credentials as a Direct-Entry Midwife
  #08-4198, Revised 01/26/17. Application for certification by credentials.
• Application for Permit as a Direct-Entry Midwife Apprentice
  #08-4228, Revised 01/26/17. Permit is valid for two years from the date issued.
• Notification of Addition to Primary Preceptor for Apprentice Permit Holder
  #08-4228c, Revised 10/29/14.
• Application for Direct-Entry Midwife Apprentice Preceptor
  #08-4240, Revised 11/29/12.
• Emergency Transport/Incident Report
  #08-4551, Revised 09/01/10.

Renewal Applications

• Biennial Certified Direct-Entry Midwife License Renewal Application
  #08-4256, Revised 10/01/18
• Jurisprudence Questionnaire
  #08-4696, Revised 11/11/16
• Procedures for Reinstatement of a Lapsed Certificate as a Direct-Entry Midwife
  #08-4590, Revised 11/29/12.

Miscellaneous Forms

• Request for Examination Review
• Change of Name Form
• Change of Address Form
• Request for License Verification Form
• Request Duplicate License Form
• Credit Card Payment Form