FY26 MDHHS Doula Initiative Participant Evaluation and Stipend Application Pt. 1

Doula Initiative Participant Evaluation and Stipend Application Pt. 1
Thank you for participating in a sponsored doula training!

Please submit ONE evaluation and stipend application per person.

This application must be completed and is a mandatory requirement for reimbursement. There are two portions to this application. The first portion is an evaluation that is anonymous, while the second portion is the application for the stipend that will require you list your contact information to upload your verification documentation.

To complete the application, you will need:
1. Completed W-9.
2. Certificate of attendance for the three recorded webinars.
3. Verification of applying for the Doula Registry.
4. Verification of being a Medicaid Provider.
Sponsored Training Reflections & Evaluation
Which Organization sponsored training did you attend?*
Please select the training with the location & date you attended.
Date of training attended (please enter the final day of training)

MonthDayYear
Date
Location of training
Please provide one or two reflections that you would like the MDHHS Doula Initiative to know about your experience. Feel free to include reflections on strengths and/or recommendations for improvement. All responses will remain anonymous. *
New Doula Training Recorded Webinars
YesNo
Please provide feedback regarding the required recorded webinar trainings.*
MDHHS Doula Registry
Please provide feedback regarding the process for applying for the MDHHS Doula Registry.*
Become a Medicaid Provider
Please provide feedback regarding the process for applying to become a Medicaid provider.*
Sponsored Training Experience
YesNo
Do you have any suggestions for improving communication about the Post-Training Requirements and process for receiving the seed money stipend?*
Is there anything you wish you would have known prior to starting this process?*
Is there anything else you would like to share about your experience? *
YesNo
If yes, please provide your name and preferred email address.
This completes the first portion of the application that is anonymous.

Please click submit to complete the application.
Should be Empty:

Doula Initiative Participant Evaluation and Stipend Application Pt. 1

Sponsored Training Reflections & Evaluation

New Doula Training Recorded Webinars

MDHHS Doula Registry

Become a Medicaid Provider

Sponsored Training Experience