• Community Care Application for Montana Residents

    Funding is made possible by the Children Special Health Services Title V Program for families who reside in the state of Montana.
  • All families must have a valid prescription before we can provide donor milk, regardless of whether they are part of the Community Care Program for Montana residents. Please call your infant's doctor and ask them to fax a prescription to us. Our fax number is 503-469-0962. A link to our order form can be found on our website here.

    Please review our Notice of Privacy Practices here.

    We can't consider your application for financial aid until we have a prescription. Please give us a call at 406-531-2677  (toll free 1-800-204-4444) and we'll be happy to answer your questions about this process!

    Click to call Northwest Mothers Milk Bank

    Click to return to DonateMilk.org

  • IMPORTANT

    Please read before continuing.
  • Montana financial resourses is made possible by the Maternal Health & Child Block Grant, specifically Title V program funding. This grant is for infants who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.

    The amount of money available is limited and changes from year to year. Because of this, we will use the information you provide to determine how we can serve your infant based on our volume of donated milk  and financial resources available. Most families will qualify for just one to two weeks' worth of donor milk at a reduced price.

          Ideal candidates and highest priority for this opportunity are: 

    • Babies under six months of age
    • Families who are working on establishing milk supply but may be experiencing feeding difficulty (e.g., weight loss, jaundice, poor latch)
    • Babies with a long-term medical diagnosis
    • Babies born premature and /or spent time in the NICU
    • Families who are working on increasing milk supply to avoid reliance on breastmilk substitutes

    Click here to learn more about why we charge a processing fee

    We may ask for the following documents in addition to your application, but they are not always required:

    • Chart notes from a healthcare provider showing the medical need for donor milk and/or a Statement of Medical Need.
    • Financial documents, such as paystubs and tax forms, to verify income
  • Community Care Program for Montana Residents

    Application for Financial Aid
  • Please fill out this form with as much detail as you can. The more information you provide, the better we will be able to serve you. You will have an opportunity to share your story at the end of this form.

    If you need assistance filling out this form, we would be happy to help you.

    Click here to call Northwest Mothers Milk Bank

    • Infant Profile 
    • Infant Profile

      You may add twins or triplets at the end of this section. This form only has space for three infants. If you are caring for more than three infants at once (ex. quadruplets) please let milk bank staff know.
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    • Infant 2 Profile (if twins) 
    • Infant 2 Profile

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    • Infant 3 Profile (if triplets) 
    • Infant 3 Profile

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    • Parent Profile 
    • Parent Profile

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    • Employment and Financial Information 
    • Employment and Financial Information

    • Healthcare Information 
    • Healthcare Provider Contact

    • Demographic Information 
    • Demographic Information

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  • Share Your Story

    This helps us understand the unique challenges you are facing.
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