Mailchimp Survey

KY Lactation Resources Database Development

The Kentuckiana Lactation Improvement Coalition (KLIC) is seeking to create a comprehensive database of all breastfeeding educators, supporters, advocates, and clinical service providers in Kentucky. This information is not freely available from breastfeeding credentialing or education providers. So, we have no way to be in touch or become organized to protect, promote, and support breastfeeding nor to provide referrals to colleagues throughout the state.
Today we are seeking your help to create an internal database. Your information will not be sold, nor will you receive contacts from anyone outside of KLIC. In the future, we would contact you if a publicly-accessible database would be developed.
Please continue to the survey. THANK YOU FOR YOUR HELP!
First Name
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Last Name
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Primary Mailing Address
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Preferred email
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Subscribe me to your newsletter
Organization name (who you provide lactation activities through, whether paid or volunteer)
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Position
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City, State
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Professional Credentials (i.e. MD, RN, RD, CN, LPN, CNM, NP, etc)
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Which of the above credentials are licensed in Kentucky
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Lactation-related credentials (i.e. IBCLC, CLC, CLC, LLL-L)
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Please give your lactation-related scope / credential
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IBCLC
Counselor/Educator (i.e. Certified Lactation Counselor, Certified Breastfeeding Educator, etc. )
Peer lactation care provider (i.e. La Leche League, WIC Peer Counselor, etc.)
Other
Please identify your race/ethnicity (for statistical purposes only). Choose all that apply
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White
Black
Hispanic or Latinx
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Other
Areas of Expertise
Current Practice Information (check all applicable)
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Academic/University
Birthing Center
Community
Home Visits
Hospital
Physician Office
Private Practice
Retail
Teleconsultations
WIC
Other
Social Media platforms where you post lactation-related content
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Facebook
YouTube
Twitter
Instagram
TikTok
Pinterest
Other
Languages Spoken (check all that apply)
English
Spanish
Other
Are you a member of: (check all applicable)
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Kentuckiana Lactation Improvement Coalition (KLIC)
Lactation Improvement Network of KY (LINK)
United States Lactation Consultant Association (USLCA)
International Lactation Consultant Association (ILCA)
Other KY Breastfeeding Coalition
Thank you SO MUCH for taking the time to complete this survey. We look forward to connecting with you!

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