A Better Me Registration

A Better Me2! Registration

An online cohort to Healthy Moms, Healthy Babies, Healthy Outcomes!
Be sure to sign up for an upcoming cohort!

The first step to a Healthy Babies, Moms & Families...online! 4 sessions, 1 session per week. Each session runs 10:00am - 12:00pm. A link will be sent out to join before the first online cohort. For more information visit www.corgoodlifefoundation.org/mothers-cove or call 1-614-338-8338.
Reserve your spot in our next virtual cohort, starting in 2026!
- Expected Start Date: June 6, 2026
- Expected Start Date: October 3, 2026
A meeting link will be sent to your email as the start date approaches.
Which Start Date are you registering for?
Mother's Name

First NameLast Name
Parent/Guardian/Custodian Email
example@example.com
Are you Pregnant? If so, what is your due date?
Your Race

Other
Mother's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Father/Guardian/Custodian Name

First NameLast Name
Father's Email
example@example.com
Father's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Are you a U.S. Citizen?
Family Household and Income

Using the chart below, determine if the household income is at or below 200% of the 2019 Federal Poverty Level limits. Select the applicable household family size and monthly income that matches the income status for the applicant family.
Number of household members
Is the family's total income at or below 200% of the Federal Poverty Level based on household size?
Children in Household
Name

First NameLast Name
Age
Name

First NameLast Name
Age
Name

First NameLast Name
Age
Name

First NameLast Name
Age
How did you hear about the upcoming Mothers Cove cohort?
Comments
Self Attestation
Parent/Guardian/Custodian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

A Better Me2! Registration

Be sure to sign up for an upcoming cohort!

Children in Household