Below are all required forms used to document the supervised apprenticeship requirements of the program. These include experience documentation forms, evaluations, and preceptor-specific forms. 

You may return these forms by scanning and emailing or sending in postal mail.

Forms documenting apprenticeship experience, evaluations, and preceptor forms are filed according to the schedule detailed below. If you have any questions, please contact us by phone (802-989-7467) or email

Schedule for Filing Forms (with linked PDF files)

At the onset of apprenticeship:

Student completes and submits to NMI: 

The following forms are available via DocuSign, which is the easiest way to complete them. Please email us your preceptor’s contact information and we will send them out.

Preceptor completes and submits to NMI: 

Together, student and preceptor provide to NMI


During apprenticeship Observe and Assist experience: 

File within each quarter, no later than the end of the quarter (March, June, Sept., Dec., see Academic Calendar)

*Note: NMI has chosen to organize documentation of clinical experience by client so that all care with each client is located on one form. This way of documenting is meant to reflect our belief in seeing clients and their care as an indivisible whole rather than as a series of separate, unrelated experiences that fulfill "numbers" quotas. However, in some instances - especially when an individual client is seen only once or twice - the individual client forms are less appropriate. In this instance, you are welcome to use our high volume clinical site forms that organize experiences by type of experience rather than by client. 

File after every 3 months of apprenticeship Observe and Assist experience (may coincide with quarterly filing):

If Preceptor has completed W-9 and chosen to invoice NMI for exams and births attended with Student, file within each quarter:


During apprenticeship Supervised Primary Care experience:

File within each quarter, no later than the end of the quarter (March, June, Sept., Dec.,see Academic Calendar)

*Note: NMI has chosen to organize documentation of clinical experience by client so that all care with each client is located on one form. This way of documenting is meant to reflect our belief in seeing clients and their care as an indivisible whole rather than as a series of separate, unrelated experiences that fulfill "numbers" quotas. However, in some instances - especially when an individual client is seen only once or twice - the individual client forms are less appropriate. In this instance, you are welcome to use our high volume clinical site forms that organize experiences by type of experience rather than by client. 

 Notes on Forms 52-53: Forms 52 and 53 provide space for four evaluation cycles, after every 5 SPC births. Copies of Forms 52/53 should be filed with NMI each quarter. Students and preceptors continue using the originals of Form 52 and 53 for each subsequent 5 SPC birth evaluation cycle. When a skill receives a 4 from the preceptor on form 52, the preceptor signs next to the skill in provided box.
It is expected that students will have attained a rating of 4 on all 722 required skills after attending 20 preceptor-supervised student-primary births. If a student needs to provide additional evaluations in order to attain a 4 rating on all skills, please reuse forms 52 and 53. 
When student attains a rating of 4 on all required skills on forms 52 and 53, student files complete version of these forms with NMI and keeps a copy for themselves. 

If Preceptor has completed W-9 and chosen to invoice NMI for exams and births attended with Student, file within each quarter:

If Student has access and is able to attend, file within each quarter: 

  • Peer Review Log (optional) - Provide date(s) of peer review attendance. No further details are required


Upon completion of apprenticeship:

  • All the above forms completed and on file at NMI office.

  • Copy of current cards for CPR (adult and infant), and Neonatal Resuscitation - file photocopies or scans of front and backs of certification cards with NMI office. These are also a required for the NARM Examination application

  • Skills Requiring a Second Signature - Students must obtain signatures on this form from a midwife, or other practitioner who is trained and credentialed to perform these skills. This second signature is in addition to the documentation completed by the student’s preceptor

  • When ready to graduate, complete and submit Exit Survey to NMI office.