The Little Timmy Project Support Form
Please fill out this form to list needs. After submitting, you must go to our site to schedule your appointment as listed on the shop page of our website. We have listed other options to select as we can connect you and your family to resources in your community.
Your information is always private. We collect data so we can better support what our community needs.
****IF YOU HAVE SHOPPED OR RECEIVED A DELIVERY IN THE LAST 90 DAYS, please wait to submit another form. We track these and will cancel these appointments.
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Address -- We will need this in order to drop items off so please make sure that it's correct:
Which of the following best describes you?
Asian or Pacific Islander
Black or African American
Hispanic or Latino
Native American or Alaskan American
White or Caucasian
Multiracial or Biracial
A race/ethnicity not listed here
Are you pregnant or expecting?
Yes I am currently expecting (please make sure to fill out your due date in the next field)
No but I delivered within the last 6 months
No but I have young children over 6 months
No (I am reaching out for someone else)
If you are pregnant, when are you due?
Do you have other children? Please list age of each. If you do not, please write in "NA".
Please check any of the programs you are currently enrolled in:
Nurse Family Partnership
None of the above
Clothing (Check options below for specific sizes and genders)
Pack N Play
Pack N Play Sheets
Diapers & Pull-ups ** ALL COME WITH WIPES (check sizes below)
Maternity Clothing (please include sizes in next field)
Breast Pump (accessories + supplies included)
Post Partum Supplies
Breast Feeding Pillow (ie: Boppy)
Bottles & Sippy Cups
Bottle Cleaning Supplies
Baby Blankets & Bedding
Sleep Sacs & Swaddlers
Baby Carriers (Slings)
XL+ (limited availability)
Clothing for Boys
2T (2-3 years old)
3T (3-4 years old)
Clothing for Girls
2T (2-3 years old)
3T (3-4 year old)
Do you need shoes? If so, what size and gender?
What Diaper Sizes do you need?
Food Pantry Information
Childbirth Education Classes (if you're expecting)
Mental Health Support
Income Assistance Information
Virtual Prenatal Yoga (if you're expecting)
Employment information if you're looking for work
Bus Pass - how often do you ride?
If you are pregnant, would you be interested in a birth doula or postpartum doula?
Not pregnant/Not interested
Do you have access to transportation?
Would you like to tell us your birth story? Please do some here (we maintain all confidential information and will never share your name or personal information with anyone)
Please list other services/support you need assistance with. We will help as best we can and will try to connect you with resources in your community.
What is your preferred language?
This is STEP ONE of TWO. After submitting this form, you will be able to schedule an appointment via STEP TWO on our shop page.
A copy of your responses will be emailed to the address you provided.
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