Marquette County Family Doula Scholarship Application
Thank you for applying! In order for applications to be considered by our committee, the individual seeking doula services must directly apply (nominating someone else will not be considered). Nominee fully understands that just because they apply, it DOESN’T guarantee doula services. Application Due Date: Due on or before 11:59pm on 12/1/17. Any questions? Please contact us at info@doulasofmarquette.com or 906-869-0000.
Name: *
Your answer
Contact Information (Phone/Email) *
Your answer
Partner's Name (if applicable):
Your answer
Do you live in Marquette County? *
Will you be delivering at UPHS-MQT or UPHS-BELL? *
Who is your Doctor? *
Your answer
Is this your first birth? (If not, what birth will this be?) *
Your answer
Approximate Due Date (Must be after 3/1/18 to qualify) *
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Are you currently WIC eligible and can you provide proof? *
Currently who is the biggest support person for you in your pregnancy? *
Your answer
Why are you hoping to have the support of a doula for your birth? *
Your answer
Who else will be attending your birth? *
Your answer
Talk to us about some of your hopes and desires for your birth. *
Your answer
How did you hear about us? *
Your answer
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