Teen Outreach Program Application
This program provides support, education, and resources to young mothers, ages 13-
19 through a virtual experience. All face to face interactions are on hold at the moment. Classes are conducted by a certified lactation counselor (CLC) using Life’s Best Beginnings evidence-based curriculum, including assessments and baby weigh-ins.
The program is incentive-based meaning that each time a teen mother attends a
session they will receive a gift card, baby gift, breastfeeding gift, and/or other
incentives. One large incentive for each teen mother will be given at the conclusion of the program. Please fill out the form below and we will contact you if you meet the qualifications.
First & Last Name
Date of Birth
Child(rens) Name & Age(s)
Number of individuals in your household, including yourself
1 (but I am expecting)
Do you have a device that will allow you to attend virtual sessions?
How will participating in this program benefit you and your family?
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