Mama Needs a Hand Application- Prince George's County- District 7

Mama Needs A Hand Application

The Nu You Inc is thrilled to serve 1,000 moms in Prince George’s County through The Mothers First Initiative in partnership with Community on the Frontline and Councilwoman Krystal Oriadha. This expanded effort allows us to bring meaningful, on-demand support to mothers during pregnancy, postpartum, and early motherhood. Please read the terms and conditions for all the details about “Mama Needs a Hand.” While we may not be able to serve every mom immediately, our goal is to meet as many needs as possible.We are putting mothers in the center of care.
Full Name

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Method of Contact
Family Information
Do you have children? (If yes, proceed to the next questions within this section.)
If yes, proceed to the next questions.
Which best describes you?
How many children do you have?
What are the ages of your children?
Do you have any pets? If so, what kind?
What's your shirt size? Just in case we want to leave you a gift :)
Do any of your children have special needs or require additional support? If yes, please provide details.
Current Challenges
What is your primary reason for applying for the "Mama Needs a Hand" service?
What specific challenges are you currently facing as a mom? (Select all that apply)

Other
If other, please specify.
What day of the week would you like to be served? Click the preferred day(s)
Have you experienced any significant life events in the past year that have impacted your well-being or your ability to care for your children?
On a scale of 1–5, how overwhemled do you currently feel in your role as a mom?

1

2

3

4

5

1 is Not overwhelmed , 5 is Extremely Overwhelmed
Support Needs
Which areas of support would you benefit from the most? (Select all that apply)

Other
If other, please specify.
How often would you need assistance?
What time of day do you typically need the most support?
Eligibility and Commitment
Do you have a reliable mode of communication for coordinating service with the Mom assistants(e.g., phone, email)
Are you willing provide pre and post survey based on experience?
Additional Information
Have you received assistance from “Mama Needs a Hand” or similar services in the past?
If yes, please provide detail.
Is there anything else you would like us to know about your situation or how we can best support you?
How did you hear about this service?

Other
Consent and Agreement
Signature
"Mama Needs A Hand"

We are thrilled to support 1,000 moms in Prince George’s County through The Mothers First Initiative in partnership with Community on the Frontline and Councilwoman Krystal Othide. This expanded effort allows us to bring meaningful, on-demand support to mothers during pregnancy, postpartum, and early motherhood.Please read the terms and conditions for all the details about “Mama Needs a Hand.” While we may not be able to serve every mom immediately, our goal is to meet as many needs as possible and brighten the days of mothers across the county as this initiative grows.Applications will be reviewed starting on 2/24/25. .
Should be Empty:

Mama Needs A Hand Application

Family Information

Current Challenges

Support Needs

Eligibility and Commitment

Additional Information

Consent and Agreement

"Mama Needs A Hand"