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Application for Postpartum Doula Grant
Email *
Name *
First and last name
Your Date of Birth *
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Baby's Estimated Due Date *
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Phone number *
What city do you live in? *
Do you identify as BIPOC (Black, Indigenous, Person of color)? *
If you answered yes, would you like the UDA to try and match you with a BIPOC doula?   *
If you would you like the UDA to try and match you with a BIPOC doula, what ethnicity do you identify with?   *
Is English your native language? *
If not, what is your native language? *
Would you like the UDA to try and match you with a doula who speaks your native language?   *
Do you have an FSA or HSA? *
Are you or your partner a veteran of the U.S. military? *
What number of baby is this? *
Have you had or do you currently have any Postpartum Mood and Anxiety Disorders? *
Why are you applying for this grant? The more details you provide, the better we can evaluate your application. *
Any other considerations we should take into account *
How did you hear about this program? *
Are you able to contribute any money or trade toward doula services?  If you so, please indicate a monetary value or a specific trade offering. *
Are you willing to write a review after services? *
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