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Empowering Birth Scholarship Application
Please answer the following questions to submit your application for a partial or full doula scholarship. Now accepting applications for birthing families due in October, November, December 2024
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Email
*
Your email
Name (First and Last)
*
Your answer
Phone Number
*
Your answer
Estimated Due Date
*
MM
/
DD
/
YYYY
What is your ethnicity?
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Black or African American
White / Caucasian
Latino
Native American
Asian/Pacific Isander
Other
Required
Please select all that apply
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Teenage pregnancy
1st time parent
Single parent
LGBTQI+
Pregnancy with multiples
Surrogate
None of the above
Required
You must live in Texas to be eligible for doula support. Virtual Doula support is available for those living outside the Greater Houston area. In person support for birthing people living in the Houston area. Where do you live? (City, state & if in Houston what part of town)
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Your answer
Why are you seeking doula support?
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Your answer
How do you see a doula being involved in your birth?
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Your answer
How will low cost doula services benefit you during your pregnancy & labor?
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Your answer
Scholarship support varies from partial to full scholarship. What amount is feasible for you for doula support?
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Your answer
What (if any) concerns do you have about pregnancy, labor or postpartum?
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Your answer
Thank you for your interest in scholarship doula services. Spaces are limited. You will be contacted if selected to move to the next step of the application process. Please do not schedule a doula consultation in conjunction with the application. That will exclude your scholarship application from being considered.
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