IBCLC tuition application

Lactation Consultant Exam Tuition Reimbursement
Scholarship Application

Guidelines:
1. Be an active member of a local chapter of The New Mexico Breastfeeding Task Force.
2. Application is to be mailed to The New Mexico Breastfeeding Task Force by
July 1 the year you are taking the exam.
3. Recipients must pass the exam to receive the scholarship.
4. If you are awarded a Lactation Consultant Exam Reimbursement scholarship, mail a copy of
your exam oresults to the Task Force and a check will be mailed to you.
5. Recipients will be reimbursed for the early bird tuition.
6. A total of 3 Certification and 3 Recertification Scholarships will be rewarded.

Name: _______________________________________

Address:_____________________________________

____________________________________________

Phone:_(_____)_______________________________

Email address:________________________________

Name of your Local Chapter of The NM BF Task Force:

___________________________________________________________________________

How long have you been a member?______

With what projects have you been involved

___________________________________________________________________________

___________________________________________________________________________

Signature of applicant:__________________________________________________________

Signature of Chair of local Task Force you of which are a member:

_______________________________________________