Aid - Home Girls Doula Services

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Info on Aid Packages

AID PACKAGE QUALIFICATION SURVEY

Since every mama needs a Home Girl, we've been able to put aside funds to make available as aid packages for those who qualify. To help the team determine your eligibility, please complete and submit the following survey.

Please note: we do not offer discounts. The aid packages are assigned strictly on a need-based determination and are only for those who would be otherwise prohibited from receiving services based on cost alone.

* Indicates required field

Are you regularly able to meet all of your basic needs (food, housing, transportation)? *

Yes Usually, but it can be stressful No, I regularly sacrifice basic needs

Do you have debt that prohibits you from affording basic needs? *

No Sometimes Yes

Which option most accurately represents your housing situation? *

I own my home/I rent a high-end home I rent a home that supports my basic needs My housing situation is insecure, unstable, or irregular

How do you get around? *

I own a car Taxi / Ride-share services Public transportation

Are you employed? *

Yes, by choice/No, I do not need to work Yes, I am fully employed I am underemployed/No, I am unemployed

Which best describes your access to healthcare? *

I am fully insured and have regular access to healthcare I am insured for emergencies with high out-of-pocket costs I receive government assistance for healthcare or I am fully uninsured

Do you have financial savings? *

Yes, I have regular access to savings Yes, I sometimes access savings for basic needs No, I have no access to savings

How do you take time off for vacation? *

I receive paid time off and can afford one or more vacations per year I can afford to take time off for about one unpaid vacation each year I cannot afford to take time off for vacation

Name *

First

Last

Email *

By clicking send, you acknowledge that answering this questionnaire does not guarantee access to aid. Aid will be determined on a case-by-case basis and is fully at the discretion of the Home Girls team. Your answers will never be shared with anyone outside of the Home Girls organization and will only be used by the team to evaluate aid qualification.

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