Join or Update your profile

To be listed on this register you must have graduated from the Perinatal Support Worker Program. In order to be added to to update your profile, please use the form below.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Address *

Line 1

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City

State

Zip Code

Country

Please select the closest statement *

I have completed my in class PNSW program and working on my practicum. I have graduated from the PNSW program.

What year did you start your practicum or graduate from the program? *

Upload your in class completion certificate or graduation certificate. *

Max file size: 20MB

Upload your proof of OPSWA membership *

Max file size: 20MB

Upload your Back check *

Max file size: 20MB

Upload your insurnace *

Max file size: 20MB

Upload your CPR *

Max file size: 20MB

Comments or questions *

I understand that filing this request does not guarantee my acceptance onto the registry. Once your submission has been reviewed, someone from our team will be in touch via email. *

I understand

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