Pregnancy Assistance

This form should be used if applying for assistance due to high-risk pregnancy or pregnancy complications.

As of November 1, 2020, acceptable verification has to fall under one of the following categories:

 
  1. A healthcare provider verification form submitted online on our website at www.colettelouise.com that is appropriately filled out by the third party with complete name, title, and contact information.
  2. A healthcare provider writing a letter on the appropriate letterhead and emailing said letter directly to us at michelle@colettelouise.com. The email must come from whoever wrote the letter and it must be from their official work email and include their full name and contact information in either the letter or the email.
  3. In cases of loss, documentation submitted or sent from either healthcare provider or parent applying that is official government or hospital paperwork. This may include a death certificate, the official paperwork that hospital completes for a death, or a detailed medical write up (not discharge paperwork) that shows the logo and contact information for the hospital or doctor as well as contact information for follow up.
 

Our applications are down for a break as we prepare for and then recover from our fundraiser, Night at the Races. Applications will reopen on November 25. Any pending applications will be reviewed and processed during this time. Approved applications will continue to get paid as normal, but may be slightly delayed.