CALCULATION OF LACTATION SPECIFIC CLINICAL PRACTICE HOURS WITHIN THE LAST 5 YEARS

Using the table below, provide self-documentation of your hours of experience providing clinical breastfeeding care
WITHIN THE 5 YEARS IMMEDIATELY PRIOR TOIBLCE EXAM APPLICATION

% time providing
lactation and
Total weeks Average hours
breastfeeding care
Month/Year Month/Year worked, excluding worked per
TOTAL LACTATION
started ended leave week Total hours
PLACE OF WORK / EXPERIENCE (*required SPECIFIC CLINICAL
WITHIN THE WITHIN THE worked
information) PRACTICE HOURS
LAST 5 YRS LAST 5 YRS (*required (*required
information) information)
(do not include %
symbol)

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
TOTAL LACTATION SPECIFIC
CLINICAL PRACTICE HOURS: 0