---
title: Certified Breastfeeding Counselor Application Form Template | Paperform
description: Complete CBC certification application form template with lactation training verification, peer counseling hours tracking, exam registration, and secure payment processing.
url: "https://paperform.co/templates/certified-breastfeeding-counselor-application"
type: static
generatedAt: "2026-03-28T00:43:16.522Z"
---

[← Back to free form templates](/templates/)    ![Certified Breastfeeding Counselor Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/certified-breastfeeding-counselor-application.png)
    [Preview](https://_preview.paperform.co/ai-template/certified-breastfeeding-counselor-application) [Use this template for free](/create?ai-template=certified-breastfeeding-counselor-application)    [Application Forms](/templates/category/applications/) [Healthcare](/templates/industry/healthcare/)[Education](/templates/industry/education/)[Nonprofit](/templates/industry/nonprofit/) [Nurse](/templates/role/nurse/)[Social Worker](/templates/role/social-worker/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Nonprofit Director](/templates/role/nonprofit-director/)[Doula & Midwife](/templates/role/doula/)     About this free form template
### Certified Breastfeeding Counselor Application Form

Becoming a **Certified Breastfeeding Counselor (CBC)** is a rewarding step toward supporting new mothers and families during one of the most important phases of early parenthood. Whether you're a doula, nurse, community health worker, or passionate advocate for maternal health, CBC certification validates your knowledge and commitment to evidence-based lactation support.

This **CBC application form** is designed to streamline your certification journey. It collects all the essential information—from your lactation support training hours to peer counseling experience—and registers you for the CBC exam, all in one place. No more juggling multiple PDFs, emails, or spreadsheets.

#### Why CBC certification matters

Certified Breastfeeding Counselors play a vital role in **community-based lactation support**, particularly in underserved areas where access to International Board Certified Lactation Consultants (IBCLCs) may be limited. CBCs provide education, encouragement, and practical guidance to breastfeeding families, helping to improve breastfeeding initiation and duration rates.

For healthcare providers, social workers, and peer support coordinators, CBC certification demonstrates a foundational understanding of lactation physiology, common challenges, and culturally sensitive counseling techniques. It's also a stepping stone for those considering advanced lactation credentials.

#### What this form does

Our CBC application form walks applicants through:

 - **Personal and contact information** with professional background details
 - **Training verification**, including course name, provider, completion date, and total hours
 - **Peer counseling hours documentation**, with supervisor contact details and setting descriptions
 - **Work and volunteer experience** related to maternal and infant health
 - **Exam registration preferences**, including test date and location selection
 - **References** from supervisors or mentors who can attest to your readiness
 - **Payment processing** for application and exam fees

The form is designed with conditional logic, so applicants only see questions relevant to their training pathway. For example, those with nursing or midwifery backgrounds may have different prerequisite pathways than peer counselors or doulas.

#### How Paperform makes certification applications easier

Traditional certification applications often involve mailing documents, tracking down signatures, and waiting weeks for confirmation. With **Paperform**, the entire CBC application process becomes transparent and efficient:

 - **Integrated payments** via Stripe or PayPal let applicants pay their exam registration fee securely within the form
 - **File uploads** for training certificates, counseling logs, and reference letters keep everything organized in one submission
 - **Conditional logic** adapts the form based on training type, eligibility pathway, and exam location preferences
 - **Automated confirmations** send applicants an instant summary of their submission and next steps
 - **Stepper workflows** can route applications to certification boards for review, trigger background checks, notify references, and update applicant tracking systems—all without manual data entry

For organizations offering CBC training programs, Paperform helps you manage hundreds of applications without drowning in spreadsheets. And for individual applicants, it means a faster, more professional experience that respects your time.

#### Who this form is for

This template is ideal for:

 - **Lactation support organizations** offering CBC certification and exam coordination
 - **Public health departments** and WIC programs training peer counselors
 - **Hospitals and birthing centers** certifying staff in breastfeeding support
 - **Nonprofits and maternal health advocates** building community-based lactation networks
 - **Training providers** who need a streamlined application and registration process

Whether you're certifying 10 counselors a year or 500, this form adapts to your workflow.

#### Extend your workflow with Stepper and Papersign

Once an application is submitted, **Stepper** (stepper.io) can automate the entire certification workflow. For example:

 - Send a personalized confirmation email with exam prep resources
 - Notify the certification coordinator to review training documentation
 - Create a task in your project management tool to schedule the exam
 - Update your applicant database with submission details
 - Trigger a follow-up email sequence with study tips and exam logistics

If your certification process requires signed agreements, code of conduct forms, or scope-of-practice acknowledgments, **Papersign** (papersign.com) lets you send those documents for eSignature immediately after the application is submitted—keeping everything linked for a complete audit trail.

#### Built for professionals who care about the details

CBC applicants are serious about their training, and your application process should reflect that professionalism. Paperform gives you the design flexibility to create a form that feels like an extension of your organization's brand—not a generic Google Form. Add your logo, choose fonts and colors that match your website, and include welcoming images or video testimonials from current CBCs.

With Paperform's **SOC 2 Type II compliance** and data residency controls, you can trust that sensitive applicant information—like references, employment history, and payment details—is handled securely and in line with data protection regulations.

#### Get started today

If you're a lactation support organization, training provider, or certification body looking to modernize your CBC application process, this Paperform template is your starting point. Customize the questions to match your specific certification requirements, connect your payment processor, and start accepting applications in minutes.

Thousands of healthcare providers, educators, and nonprofits trust Paperform to handle high-stakes applications with care. Join them, and give your CBC applicants the seamless, professional experience they deserve.
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