Pregnancy & NICU

This form should be used if applying for assistance due to high-risk pregnancy, pregnancy complications, bed rest, hospital stay, or premature birth, NICU stay.

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 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 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.

Applications are currently closed as we wrap up the quarter and take a small break! Applications submitted before we closed will continue to be reviewed and processed. We will reopen to applications on October 17. Thank you very much for your understanding and we look forward to serving you again soon!

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