Application Form

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Application Form

This year, in honor of Gertrude Hargett, the G.L.E.W. Foundation is partnering with our fiscal sponsor, The Shared Harvest Foundation a 501(c)3 organization to support the transportation, financial and logistic needs of women of color who are seeking access to safe abortion care. If you are a mother in need of financial support to get the care you need we welcome you to fill out the application below OR Text "GLEW" to 917 456 9396 to be connected with a healthcare professional.

You can find more about the G.L.E.W. Foundation by visiting www.glewfoundation.com.

Email *

Name *

First and last name

Email *

Phone number *

Home Address *

Are you a African American single mother? *

Yes

Tell us about yourself. What makes you unique? What are your passions? What drives you? What life experiences have shaped you? *

Anything else you would like to tell us?

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