<p> Application for Accreditation as a La Leche League Leader</p><p>Contact and Family Information</p><p>Last Name First Name (plus nickname, if preferred) Partner's name (optional)</p><p>Email Address Telephone Number </p><p>Mailing Address </p><p>My child(ren)’s name(s), birth date(s), and length of time breastfed: </p><p>Group and Leader Information I have been attending since LLL Group Name </p><p>I (have) (have not) previously attended Dates: LLL Group Name(s) I (have) (have not) previously applied for leadership When and Where</p><p>I did my pre-application dialogue with Leader(s) Name(s) and Email Address(s)</p><p>I shall be working on my application with Leader(s) Name(s) and Email Address(s) Membership and Resource Information I am a dues-paying member of LLL. Payment of membership date: I own a copy of The Womanly Art of Breastfeeding: *Date of edition * If not a US edition, what language? I have read The Womanly Art of Breastfeeding. I own/plan to order a hard copy of Leader's Handbook.</p><p>I have accessed/plan to access Leader's Handbook electronically via the LLLI website. How would you like to correspond? Please indicate your preferred method(s): email postal email other (please specify) Have you held any Group jobs? If yes, which? </p><p>I currently (do) (do not) volunteer for another breastfeeding/parenting organization. Position Name of organization Which published resource materials (where applicable, the most recent editions) have you discussed with your Leader(s)?</p><p>May 2015 LLL USA Application for Accreditation as a La Leche League Leader Page 1 of 2 ____ The Womanly Art of Breastfeeding ____ LLLI website, other LLL websites ____ Thinking About LLL Leadership? ____ Breastfeeding Today, New Beginnings ____ Leader's Handbook ____ Leader publications (e.g. Leader Today) ____ Breastfeeding Answers Made Simple ____ Area Leader publication ____ Pamphlets/information sheets ____ Group Library books ____ Appendices 17 & 18 (LLLI PSR Notebook) ____ Other ____ Overview of Application Work for Leader Accreditation </p><p>In which, if any, of the following optional La Leche League activities and events have you participated? ____ Interested Mothers Workshops ____ Nursing Toddler Meetings ____ Chapter Meetings ____ Area Conferences ____ Communication Skills Sessions ____ LLLI/Affiliate Conferences Group Evaluation/Enrichment Meetings ____ Other Groups’ meetings ____ Other </p><p>Mothering Experience Prerequisite Information Please give some examples showing how you value nursing at your breast as the optimal way to nourish, nurture, and comfort your baby:</p><p>Please provide some examples which show that you recognize, understand, and respond to your baby’s need for your presence as well as your milk. </p><p>If you have experienced regular and ongoing separation from your baby in the early years, please describe the situation (use additional pages if needed), including any impact of separation on mothering through breastfeeding, and the arrangements you have made to lessen the separation, and/or to minimize disruption of nursing at the breast. How did you know your baby was ready for separation?</p><p>------I understand that I will dialogue about my personal history of breastfeeding and mothering with a representative of the Leader Accreditation Department (LAD), who will personally correspond with me regarding my application. This will be a sharing of thoughts and experiences as they relate to breastfeeding knowledge; LLLI philosophy, policies, and goals; and the Leader's role. </p><p>I understand also that I will sign the following statement to be accredited as a La Leche League Leader at the completion of my application work: “I am personally committed to good mothering through breastfeeding as presented in The Womanly Art of Breastfeeding and other LLL publications. I agree to represent La Leche League as a Leader in accordance with the LLLI Bylaws and policies. I will resign from this position if, for any reason, I find that I can no longer represent La Leche League in accordance with this agreement.” </p><p>Name Date Please check with your supporting Leader regarding payment of the application fee. Please send this form to the LAD representative for your Area. Thank you! </p><p>May 2015 LLL USA Application for Accreditation as a La Leche League Leader Page 2 of 2</p>