Undergraduate Student Application

First name*

Last name*

Select your requested degree*

What semester are you applying for (i.e., first semester of enrollment/taking classes)? *

Street Address*

City*

State/Province*

Postal code*

Country*

Telephone number*

Alternate phone

Email address*

Birth date*

Birth place*

Do you expect to practice in Washington, California, or Canada?*

By checking this box, I consent to do business electronically with Midwives College of Utah. I understand that student business will be conducted electronically such as (but not limited to) admissions, registration, Form 1098-T, collection notices, invoices, financial aid correspondence, general correspondence, assignment submission, feedback and grading.*

Do you already have an MCU User account from a prior application?*

Choose a Username*

Choose a Password*

Confirm password*

Existing Username*

Existing password*

When did you submit your previous application?*

Was your $50.00 application fee paid within the last twelve months?*

Have you ever been enrolled in an MCU program (other than continuing education courses) previously?*

Which program were you enrolled in?*

Please provide dates of enrollment*

Did you complete the program?*

Please provide reason for withdrawal*

Date of withdrawal*

Have you ever enrolled in continuing education courses at MCU?*

When were you enrolled?

What classes are you enrolled in?*

What percentage of your courses are complete as of today's date (you may locate this information under the student menu box click on "My Classes")?*

Courses completed*

Date*

Grade*

Courses not completed in required timeframe*

Date*

Is English the primary language that you spoke in the home from the time you learned to speak through childhood?*

Is your TOEFL score 88 or higher?*

Do you speak any languages besides English?*

Please indicate which other languages you speak.

What are your religious or spiritual affiliations (optional)?

Race/Ethnicity (please check all that apply)*

Tribal Affiliation

Latina/Hispanic/Spanish

Please identify any learning difficulties that may require accommodations.

Have you ever been declared mentally incompetent in a legal proceeding?*

Do you have any pending criminal charges against you or have you ever been convicted of a felony or misdemeanor other than traffic violations in federal, state, local, military, tribal court or another country?*

Please explain criminal charges or felony/misdemeanors.*

Has any government or regulatory agency ever found that you committed child abuse or neglect, elder abuse or neglect or misappropriated (improperly took or used) the property of a person or client?*

Please explain abuse/neglect.*

Are you planning to apply for Federal Financial Aid?*

Have you completed your fafsa and identified MCU as a school you hope to attend?*

Letters of Recommendation

Name of recommender 1*

Phone number of recommender 1*

Letter of Recommendation 1*

Name of recommender 2*

Phone number of recommender 2*

Letter of Recommendation 2*

Have you completed more than two years (full-time) of college at an accredited academic setting (college, community college, tech school, university, etc.)?*

Please upload your High School Diploma/Transcript or GED or Homeschool Transcript (REQUIRED of all applicants who have not completed two years of college credits at an accredited academic institution) *

Important notes for applicants who have attended an accredited postsecondary academic setting previously:

• We require you to have ALL transcripts for postsecondary academic coursework that was completed for credit sent to MCU. Coursework that is not identified on this application will not be considered for credit transfer. Coursework currently in progress, may be submitted after the semester for review.
• Please include any college coursework completed during high school (ie. AP courses) wherein you completed the final test and earned college credit.

In the section below, please list ALL regionally or nationally accredited post-secondary institutions that you have attended in your lifetime. If an institution is not listed on your initial application or we do not receive a copy of the official transcripts from a listed institution by the application deadline date, we will be unable to consider those transcripts for transfer credit review. Thank you.

Accredited Institution 1

Years Attended 1

Degree 1

Accredited Institution 2

Years Attended 2

Degree 2

Accredited Institution 3

Years Attended 3

Degree 3

Accredited Institution 4

Years Attended 4

Degree 4

Accredited Institution 5

Years Attended 5

Degree 5

I have requested my official transcripts from all accredited postsecondary education institutions (colleges, tech schools, universities, etc.) to be emailed directly to office@midwifery.edu OR mailed directly to Midwives College of Utah, 1174 E. Graystone Way, Suite 2, Salt Lake City, UT 84106*

Please list all former names used at previous higher academic settings

The following items are not required to be admitted to MCU, however, many of them strengthen your application. These items must be uploaded BEFORE the submission of your application in order for you to receive the additional rating points for having completed them.

Have you completed a doula training?*

Proof of doula training (.doc or .pdf file format)*

Are you a certified doula?*

Proof of doula certification from DONA or other certifying body (.doc or .pdf file format)*

Proof of childbirth education certification, if applicable (.doc or .pdf file format)

Proof of Lactation Consultant Certificate, if applicable (.doc or .pdf file format)

Proof of Birth Assistant Training Certificate, if applicable (.doc or .pdf file format)

Proof of CPM, LM and/or CNM status, if applicable (.doc or .pdf file format)

Proof of NRP certification, if applicable (.doc or .pdf file format)

Proof of CPR certification, if applicable (.doc or .pdf file format)

Additional relevant certifications or trainings

Description

File

Description

File

Description

File

Description

File

Description

File

We value strong writing and creativity in our MCU curriculum. Please answer the following questions in an essay format with a maximum of 7,200 characters. Feel free to use your own writing software to ensure that you send us your best effort. Once completed, your essay text should be pasted into the field below.

• Why are you passionate about midwifery?
• What have you already accomplished toward those goals (e.g., childbirth education, lactation education, doula work, volunteer work, community work)?
• What are your plans to support and enhance your community? What has been your community involvement thus far?
• Where do you see yourself as a midwife 10 years from now? What do you want your midwifery legacy to be?
• Please tell us how your experience and exposure to birth has led you to apply to MCU?

What do you see as your most significant challenges, commitments and/or obstacles to completing your midwifery education and the significant demands of an on-call midwifery lifestyle? Discuss your plans for meeting these challenges.*

Tell us what you know about the current challenges and political landscape of midwifery and the CPM credential, including your familiarity with your state and the national midwifery organizations.*

Tell us about midwifery and birth in your community, and describe how you plan to be a midwifery leader and community builder within the midwifery profession.*

Tell us about your ability and skills that allow you to work with women and families whose belief systems are different than your own.*

MCU is a committed ally to all underrepresented women and families who seek access to midwifery care or who strive to become midwifery providers within their communities. Do you live within a region that has not traditionally had access to out of hospital birth midwifery care or are you a part of an underrepresented community or population that has not traditionally had access to out of hospital birth midwifery care? If so, please share your goals for serving this population.*

How many births have you attended? *

Please describe the capacity you were serving in the births you attended (check all that apply)*

Have you identified possible clinical placements in your area?*

Do you have a commitment from a preceptor in your area?*

Please identify the preceptor name(s)*

If preceptors are not available in your area, how far are you willing to travel and/or relocate in order to fulfill your clinical placement requirements?*

Do you intend to apply for life experience credit? PLEASE NOTE: The Portfolio Evaluation Process application must be submitted following notification that you have been accepted for admission. For more information regarding life experience credit, please visit our FAQ page located on www.midiwfery.edu*

As a distance education program, we rely heavily on computer technology. Please describe your computer skills and ability to learn and adopt new technological skills (i.e. proficient in Microsoft Office/Adobe/email/web search/social media/uploading/downloading).*

Do you have access at home to a computer and high speed internet?*

Please identify how/when you will have access the a computer and Internet.*

Distance education requires that students are motivated and self-directed. Please describe a situation in which you demonstrated self-direction and personal motivation.*

How will you contribute to MCU's culture of midwifing midwives and the student community?*