Bump Birth & Baby Co, LLC Client Need Application

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To promote the conditions of equity and optimal birth for all people, especially those who are marginalized, I offer payment plans, sliding scale and/or scholarships for financial need. Priority will be given to marginalized groups (BIPOC, POC, LGBTQ+). Please complete this form for consideration. All responses are confidential and will not be shared with anyone other than the applicant for any reason.

Courriel *

Your full name *

Please tell me about yourself and how you identify *

I have financial need

I identify as a person in a marginalized group

Both

Neither

Obligatoire

What type of support or services are you looking for? (please be as specific as you can!) *

Please tell me any additional information that you think I should know about your current situation and why you are applying for payment plan, sliding scale and/or scholarship for financial need. *

Thank you for your submission. Your application will be reviewed as soon as possible. I will notify you by email of your eligibility or about any additional information required.

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