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. 

All forms are writable, meaning they can either be printed and completed or filled out right from your computer, tablet, etc. You will notice that the signatures portion of the forms is not writable. If you do complete your forms on your computer, you will need to print out all forms requiring signature and sign the hard copies before submitting to NMI. 

Forms documenting apprenticeship experience, evaluations, and preceptor forms are filed according to the schedule detailed below. If you have any questions, please contact Emily by phone (802-453-3332) or email

Schedule for Filing Forms (with linked PDF files)

At the onset of apprenticeship:

Student completes and submits to NMI: 

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)

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)

File after every 5 preceptor-supervised student-primary births: 

 Notes on Forms 52-53: Forms 52 and 53 provide space for four evaluation cycles. After completing Forms 52 and 53 for 5 SPC births, students file a copy of both forms with NMI. 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 original 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