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Seal of Racial Equity - Application for Individuals

-- Step 1 Application -- This application process is meant to help us find and promote access to individuals and organizations who are fully committed to the work of tackling racism and anti-Blackness. We have tried to make this application process accessible, but please let us know if there are accommodations that would help make this process easier for you Please note that the application cannot be saved - we encourage you to draft your responses in an external document The criteria that have been chosen to operationalize the goal of equity-centered birthwork and healthcare are not perfect, but are baseline recommendations for being a part of Nurturely's perinatal professional referral network. The Seal of Perinatal Equity is intended to indicate commitment to the work - it is not a certification that is "finished" but rather an indication to fellow providers and patients/clients that you are working toward care that is unbiased, antiracist, and culturally inclusive. If you do not have clear evidence of how you meet each criteria level, we will ask you to resubmit your application when you do have this evidence. Because this is ongoing work rather than a one-time certification, we ask providers to resubmit applications yearly with up-to-date demonstrations of their commitments to this work. SEAL OF PERINATAL EQUITY CRITERIA TRANSPARENCY - Ensure that all patients and clients understand your alignment with perinatal equity TRAINING - Participate regularly in antiracism education and reflection activities REPRESENTATION - Choose partners and tools intentionally that center Black and Brown representation ACCOUNTABILITY - Facilitating self-critique and accountability by encouraging reviews and feedback INTEGRATION - Prioritizing antiracism as a non-negotiable part of your policies, culture, and practices RESOURCES - Devoting personal/organizational time/money/resources to antiracism efforts -- Step 2 Application Fee -- If your application is approved: - We will send a payment request for a nonrefundable application fee (tiered, see below) to cover the administrative time to verify each application, maintain the website and referral network, and support and uplift the providers in this network. - We will send an agreement for you to sign that outlines the expectations of this program - You will be responsible for renewing your application annually *** Fee waived for paid Nurturely Perinatal Equity Advocates participants $25 - Individual community-based or culturally specific care provider $75 - Institutional healthcare professional If cost is a barrier to completing trainings or subscribing to tools like the Melanated Mammary Atlas, please reach out to Nurturely as we have many scholarship options available.

Please select that you are applying as an individual, not an organization.
Address
  • {name}
(if you would like to expand on your professional title listed above)
(including but not limited to culture, race, gender, and anything else you'd like to share)
What is YOUR personal and professional commitment to active antiracism and intersectional inclusion?
How do you committ to addressing racism, and anti-Blackness specifically, in your personal and professional life? How do you actively include intersectional identities (including but not limited to language, culture, gender, religion, nationality) in your care and work?
  • {name}
Which of the following do you use to practice TRANSPARENCY about your antiracism values as a birthworker or healthcare provider:
Please only choose options that you can provide documented evidence for (below). This is not an exhaustive list of potential options - please use the OTHER option as well.
Please upload documentation of each below.
This can include photos, screenshots, or pdf copies of documents. Must be recent within the past year.
Attach file
Drop files here
Pleas share more details of each below:
  • {name}
Which of the following do you use to engage in TRAINING around antiracism and cultural inclusion as a perinatal professional?
This is not an exhaustive list of potential options - please use the OTHER option as well.
Please upload documentation of each below (training)
This can include photos, screenshots, or pdf copies of documents. Must be recent within the past year.
Attach file
Drop files here
Pleas share more details of each below:
  • {name}
Which of the following resources do you use to ensure REPRESENTATION that centers Black and global majority people in the tools you use and the organizations you work with?
This is not an exhaustive list of potential options - please use the OTHER option as well.
Please upload documentation of each below (representation)
This can include photos, screenshots, or pdf copies of documents. Must be recent within the past year.
Attach file
Drop files here
Pleas share more details of each below:
  • {name}
Which of the following do you use to ensure your own ACCOUNTABILITY for these commitments to antiracism and cultural inclusion?
This is not an exhaustive list of potential options - please use the OTHER option as well.
Please upload documentation of each below (accountability):
This can include photos, screenshots, or pdf copies of documents. Must be recent within the past year.
Attach file
Drop files here
Pleas share more details of each below:
  • {name}
Which of the following do you use to ensure INTEGRATION of antiracism in your policies, practices, and culture?
This is not an exhaustive list of potential options - please use the OTHER option as well.
Please upload documentation of each below:
Attach file
Drop files here
Pleas share more details of each (name, description, location, timing, etc)
  • {name}
Which of the following do you use to ensure RESOURCE-PRIORITIZATION of antiracism in your budget, schedule, and strategy?
This is not an exhaustive list of potential options - please use the OTHER option as well.
Please upload documentation of each below:
Attach file
Drop files here
Pleas share more details of each (name, description, location, timing, etc)
  • {name}
Please upload a video (to be shared on our referral website) explaining your commitments and why it is important to you as a perinatal professional. (accountability)
Attach file
Drop files here
Please upload a photo to be shared publicly
Attach file
Drop files here
Anything else to add?
  • {name}

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