Financial Assistance Application

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BEBO provides financial assistance for families in Westchester county struggling to pay for professional prenatal, birth, or postpartum support. Please submit applications at least 2 weeks prior to anticipated need, as applications take 2 weeks to process, and retroactive support is not available.

First Name *

Last Name *

What are your pronouns?

Email address *

Street Address *

City *

Zip Code *

What is your estimated due date? *

YYYY

Do you live in Westchester County, NY? *

Yes

For what class/service are your requesting support? *

Childbirth Education

Birth Doula

Postpartum Doula

Breastfeeding Class

Lactation Consultant

Is there someone specific you'd like to work with? If so, please write their full name or business name under "Other." *

No, I'd like help connecting with someone who provides this service

Other:

If you have a provider you'd like to work with, please provide their contact information and website here:

Please describe the service you're seeking support for and why you're interested in this service. *

Where do you plan to deliver? *

What is the full cost of the service you're seeing? *

How much are you able to pay? *

Please describe the factors preventing you from being able to pay the full fee for this class/service. *

Please remember that applications take 2 weeks to process, and retroactive support is not available. Please make sure you've answered all application questions fully - if your application is incomplete, it will take longer for us to process. Thank you for your application!

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This form was created inside of BEBO (birth education beyond the ordinary).