An applicant for a license to practice midwifery as a certified midwife shall submit to the board in a format as prescribed by the board the following:
1. Fee. A completed application together with the fee established under section 12538;
2. Certification. Proof of a current and valid national certification as a certified midwife from the national midwifery certification board; and
3. Education. Proof of successful completion of a graduate-level education program in midwifery that is accredited by the accreditation commission for midwifery education.