---
title: Certified Lactation Consultant Application Form Template | Paperform
description: Professional IBCLC certification application form for lactation consultants. Collect clinical practice hours, health sciences education verification, and exam registration in one streamlined form.
url: "https://paperform.co/templates/certified-lactation-consultant-application"
type: static
generatedAt: "2026-03-28T00:43:16.755Z"
---

[← Back to free form templates](/templates/)    ![Certified Lactation Consultant Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/certified-lactation-consultant-application.png)
    [Preview](https://_preview.paperform.co/ai-template/certified-lactation-consultant-application) [Use this template for free](/create?ai-template=certified-lactation-consultant-application)    [Application Forms](/templates/category/applications/) [Healthcare](/templates/industry/healthcare/)[Education](/templates/industry/education/) [Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Nutritionist](/templates/role/nutritionist/)     About this free form template
### Become a Certified Lactation Consultant with Streamlined Applications

Pursuing certification as a lactation consultant is a meaningful step toward supporting families during one of the most critical periods of early childhood. Whether you're a nurse, midwife, dietitian, or allied health professional looking to specialize in lactation support, the path to becoming an International Board Certified Lactation Consultant (IBCLC) requires careful documentation of clinical hours, educational credentials, and exam preparation.

This **Certified Lactation Consultant Application** form template is designed specifically for certification bodies, training programs, and healthcare institutions that need to collect comprehensive applicant information while maintaining a professional, supportive experience. Built with Paperform, this template helps streamline the complex certification process, ensuring all required documentation is captured accurately and efficiently.

#### Why Lactation Consultant Certification Matters

IBCLCs are the gold standard in lactation care, providing evidence-based support to breastfeeding families across hospitals, clinics, private practices, and community health settings. The certification process through the International Board of Lactation Consultant Examiners (IBLCE) requires applicants to demonstrate specific clinical practice hours, complete health sciences education, and pass a rigorous examination—making the application process inherently detailed and documentation-heavy.

This form template addresses those requirements head-on, collecting everything from educational transcripts and clinical hour logs to supervisor verification and exam scheduling preferences in one organized, branded experience.

#### What Makes This Template Essential for Healthcare Certification

**Comprehensive Clinical Documentation**: The form captures detailed clinical practice hours across multiple pathways—whether applicants are coming from nursing, midwifery, or other allied health backgrounds. Conditional logic guides applicants through pathway-specific requirements, ensuring they only see questions relevant to their educational background.

**Education Verification Made Simple**: Health sciences coursework requirements vary by pathway, and this template includes sections for documenting anatomy, physiology, nutrition, psychology, and lactation-specific education. File upload fields make it easy for applicants to submit transcripts, certificates of completion, and letters from academic institutions—all in one place.

**Supervisor and Mentor Verification**: The form collects detailed information about clinical supervisors and mentors who can verify hands-on practice hours, including their credentials, contact information, and relationship to the applicant. This built-in verification trail reduces back-and-forth communication and speeds up the review process.

**IBLCE Exam Registration Integration**: Beyond certification application, the form includes exam registration preferences, testing accommodation requests, and payment processing for application fees—creating a complete end-to-end solution.

**Conditional Logic for Multiple Pathways**: Paperform's powerful conditional logic ensures applicants only see fields relevant to their specific pathway (Pathway 1, 2, or 3), reducing confusion and form abandonment while maintaining compliance with IBLCE eligibility requirements.

#### Who Benefits from This Template

This template is ideal for:

 - **Lactation education programs** managing cohorts of students preparing for IBLCE certification
 - **Healthcare institutions** supporting staff pursuing advanced lactation credentials
 - **Professional certification bodies** collecting standardized applicant information
 - **Hospital lactation departments** tracking internal certification progress
 - **Private lactation consulting practices** maintaining mentor/mentee documentation

Whether you're a small lactation education program or a large healthcare system, this template adapts to your brand and workflow while maintaining the rigor required for professional certification.

#### Automate Your Certification Workflow with Stepper

Once applications are submitted, the real work of verification and processing begins. By connecting this Paperform template to **Stepper** (stepper.io), you can automate the entire certification workflow:

 - **Automatic email notifications** to supervisors requesting verification of clinical hours
 - **CRM updates** in systems like HubSpot or Salesforce to track applicant progress through review stages
 - **Document routing** to certification review committees via Slack, email, or project management tools
 - **Conditional approval workflows** that route applications to different reviewers based on pathway or completeness
 - **Calendar scheduling** for follow-up interviews or competency assessments
 - **Automated reminders** for incomplete applications or missing documentation

These automations save certification coordinators hours of manual work each week while ensuring no applicant falls through the cracks.

#### Flexible, Branded, and Secure

Healthcare professionals expect a polished, trustworthy experience when applying for certification. Paperform's design flexibility lets you match your institution's brand with custom fonts, colors, logos, and backgrounds. Embed the form directly on your website or send it as a standalone link—either way, applicants enjoy a seamless, professional experience.

Security matters in healthcare applications. This template is built on Paperform's **SOC 2 Type II compliant platform**, ensuring applicant data is protected throughout the submission and review process. While Paperform is not HIPAA compliant, it's suitable for collecting professional credentials, contact information, and non-protected health information commonly required in certification applications.

#### Real Impact for Lactation Education and Healthcare

Lactation consultants play a vital role in maternal and infant health outcomes, and the certification process should support—not hinder—qualified professionals entering the field. By digitizing and streamlining the application experience, you remove barriers, reduce administrative burden, and help more qualified candidates achieve certification faster.

Whether you're processing ten applications per year or hundreds, this template provides the structure, flexibility, and automation potential to scale with your program. Combined with Paperform's integrations and **Stepper's** workflow capabilities, you can transform certification application from a paperwork nightmare into a smooth, efficient process that reflects the professionalism of the lactation field.

Start with this template, customize it to your specific pathway requirements and institutional policies, and create a certification application experience that honors the dedication of healthcare professionals committed to supporting breastfeeding families.
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