Application & Instructions for Initial Licensure - Midwife Apprentice

Log in to LaMED DashBoard to begin a new online initial application, complete a previously started (and saved) online initial application or to check the status of your completed online initial application.

To access a paper application, click HERE (available for a limited time)

The items listed below MUST be completed and mailed to the LSBME as part of the initial application process.

Note: notarized documents must be signed in the presence of a notary.

Oath or Affirmation
This form must be notarized. All yes answers must be accompanied by a sworn affidavit. A sworn affidavit is an explanation (in applicant’s own words) that must be typed and notarized. Note: If criminal history is found that you did not disclose, you will be required to submit a new Oath or Affirmation, a notarized affidavit as to why you did not disclose the information and a new processing fee equal to the initial licensure fee. It is important that you answer question 3 accurately and truthfully. Do not take the advice of friends, lawyer, etc.

Third Party Authorization
This form must be notarized. It authorizes LSBME to obtain information concerning the applicant from third parties.

Certificate of Dean/Registrar
Complete Section 1 as directed. Mail to professional school/university for completion of Section 2. The school/university must mail the completed form directly to LSBME.

Photograph
   A passport quality photograph must be submitted.  This photo must be a 2"x2" clear, head and shoulders photo taken within the last 6 months.

Contractual Agreement
Complete and submit this form for each preceptor.

Background Check
LSBME conducts background checks as part of the application process. Instructions and forms can be found at the link above.

§2339. Apprentice Permit
A.  An apprentice permit authorizes the permit holder to obtain the practical experience required for licensure under the supervision of a physician, certified nurse-midwife, or licensed midwife.
B.   An apprentice permit shall be issued by the board to an applicant who possesses all of the qualifications for licensure as a licensed midwife specified by §2307.A.1-3 of these rules (see below) and who submits to the board, on a form furnished or approved by the board, written verification of a contractual relationship with a physician, certified nurse-midwife, or licensed midwife who shall assume responsibility for instructing and supervising the apprentice in accordance with the rules and regulations of this Chapter and of Chapter 53.

Additional Requirements

Fee
Licensure $100.00
Fee must be paid via credit/debit card (Visa, MasterCard or Discover only) if applying online.
Fee must be paid via Personal check/money order if sending in a paper application.
​Fee is non-refundable.

Birth Certificate/Valid Visa

  • U.S. born citizen - submit a notarized copy of birth certificate

  • U.S. citizen not U.S. born - submit notarized copy of proof of citizenship (ie certificate of citizenship or consular report of birth abroad). Naturalized citizen - submit a notarized copy of birth certificate and notarized Certificate of Naturalization.

  • Non U.S. citizen - submit a notarized copy of birth certificate and notarized current Visa issued by the U.S. Citizenship and Immigration Services. (Acceptable Visas: H1B, J1, O1, NAFTA-TN or Employment  Authorization, or Permanent Resident)

Marriage Certificate/Name Change
Application for licensure in a name other than what appears on the birth certificate requires a notarized copy of official documentation of name change (ie marriage certificate).

Notarization as a “true copy”
   Request the notary to certify a copy of your birth certificate and/or marriage certificate as a “true and correct copy of the original”. If the notary will not certify the document,
   you can attest that it is a “true and correct copy of the original”. The notary can then notarize your signature.

High School Transcript
Request a transcript be sent from your high school directly to LSBME.

Verification of Other Licenses
​Verification of all state licenses are required.  Contact the state board(s) directly to obtain verification of your license.  Please note, there may be a processing fee needed.

CPR
Submit a notarized copy of current certification in cardiopulmonary resuscitation.

Other Information

Verification of Application/Licensure Status
Visit our website at www.lsbme.la.gov and log on to your account to verify the progress/status of your application.

Communication with the Board
Mailing Address - LSBME, 630 Camp Street, New Orleans, LA 70130
Questions - Contact our licensing department at licensing@lsbme.la.gov. To find the analyst directly assigned to your application, click on Contact Us.