Thrive Wellness Collective Grant Application
Thrive Wellness Collective, a 501(c)3 non-profit organization, is dedicated to providing individualized pre and postnatal care for everyone in our community. Your application is a crucial step in understanding your specific needs. Each application must include your personal contact information, household income verification, and your consent to share your experience on social media platforms. We encourage both parents to apply for the scholarship, with exceptions made for circumstances like domestic violence, where the other parent is not involved in the pregnant person's life. Our qualification process is solely income-based, ensuring objectivity. Our grant administrator will thoroughly review all submitted documents, and you will be contacted within 10-14 business days to inform you of your qualification status for subsidized services.
Other Resources
We invite you to explore the various other services we currently offer and support. These include doula support, in-home postpartum support, pregnancy loss visits, maternal mental health visits. Additionally, we encourage you to take advantage of our free breastfeeding support group every Monday at 10 am in Pacific Beach at Cafe of Life and our New Parent support group every month on the 1st & 3rd Tuesday at 1 pm at Tourmaline Birth Center. Littles and partners are encouraged and welcome. Visit our website for more details. We recommend visiting these support groups while pregnant to build knowledge and community.
What services are you requesting?
What services are you applying for? (Please note if you are receiving birth doula services through medi-cal you may only apply for postpartum doula services through Thrive and vice versa.)
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Please Select
Doula Birth Support Services
Doula Postpartum Services
Maternal Mental Health Visits
Midwifery Postpartum Home Visits
Doula and Postpartum Home Visits
Name:
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First Name
Last Name
Date of birth:
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Social Security# or document numbers for legal immigrant:
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Ethnicity:
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Citizenship or immigration status:
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Age:
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Address:
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone number:
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Email:
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Estimated Due Date: (if applicable)
Name, Title, and Contact Information of Your Midwife/Doula/Mental Health Provider (if applicable)
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Partners Name (if applicable):
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First Name
Last Name
Date of birth:
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Partners social security# or document numbers for legal immigrant:
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Citizenship or immigration status:
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Partners Phone number:
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Partners Email:
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Do you currently qualify and have full Medi-Cal?(other than pregnancy Medi-Cal)
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Yes
No
Valid form of identification (front and back):
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If you have full Medi-cal upload a valid/current copy of your card and proof of residency . If you do not have Medi-cal you will need to upload the following proof of income documents for you and your partner: Tax returns for the previous 3 years, Employer and income information: (pay stubs, W-2 forms) Proof of residency which can include: Insurance card, Vehicle registration, Credit card bill, Utility bill, Bank statement, Mail from a federal, state, or local government agency
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Cancel
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Name, email and phone number of your care provider
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Date
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Month
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Day
Year
Date
FINANCIAL WORKSHEET
Applicant
Partner
How many people in the household:
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Please fill out expenses for both parties (combine both) IF you do not currently have active Medi-cal (non pregnancy):
Monthly Expenses $
House Rent/Mortgage Payment
Property Taxes
Homeowner's Insurance
Homeowner's assoc. fees
2nd Mortgage
Credit cards (min. monthly pmt)
Student Loans
Tuitions
Other loans
Car Loan
Automobile Insurance
Car gasoline
Car maintenance
Home phone expenses
Cellular phone
Cable / Internet
Home Electricity
Home Gas
Sewer / Water
Garbage
Groceries
Uniform (dry clean)
If Not Deducted by Employer:
Health Insurance
Life Insurance
Alimony / C ild Care Expenses
(Not Insured) Medical bills
(Not Insured) Medications
Church (donations)
Membership dues
Other expenses
Monthly $
Applicant Gross Salary
Net Salary
Partners Gross
Net Salary
Alimony / Child Support
Pension/Retirement
Disability/Food Stamps
Room Rental income
Rental property income
Other (Contribution)
Available Funds Today
Checking account
Savings account
Other
Total Available
$ You can pay towards your care
$ Partner to pay towards care
$ Family can offer towards care
Total Monthly Expenses
Total Monthly Income
Final Net Numbers (+/-)
Applicant:
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Date
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Month
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Day
Year
Date
Partner:
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Date
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Month
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Day
Year
Date
How did you hear about Thrive? (please be specific and share name and email so we can send a Thank You note)
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Submit Application
Submit Application
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