Family Information
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 review the attached Terms and Conditions for complete details on the program. While our goal is to meet as many needs as possible, please note that services are subject to capacity constraints. To qualify for no-cost support, you must reside in one of the following eligible zip codes: 20746, 20747, 20743, 20748, or 20745.Moms living outside of these zip codes are still welcome to receive support through our self-pay service options. We look forward to growing this initiative and brightening the days of mothers across the County.
Please Watch
Example of Mama Needs A Hand
Please select which describes you best
Self referral
Client Referral
If this is a client referral , Please add the organization the referral is coming from. All clients information should be added below. Please place N/A if this is a self referral.
Full Name
First Name
Last 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
City
State / Province
Postal / Zip Code
Which District 7 zip code do you live in? ( Moms who reside outside of the following Zip codes may qualify for Paid support)
*
20746
20747
20743
20748
20745
Preferred Method of Contact
Phone
Email
Text
Do you have children? (If yes, proceed to the next questions within this section.)
Please Select
Yes
No
If yes, proceed to the next questions.
Which best describes you?
Mom
Legal Guardian ( Woman)
How many children do you have?
Moms must be currently pregnant or have a child 3 or under to qualify . Which best describes you?
I am currently pregnant
I have a child under 1
I have a 1 year old
I have a 2 year old
I have a 3 year old
None of these describe me
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If you marked " None of these describe me" you don't qualify for the program at this time.
Do you have any pets? If so, what kind?
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)
Lack of childcare
Financial difficulties
Limited support system
Physical or mental health concerns
Other
If other, please specify.
What day of the week would you like to be served? Click the preferred day(s)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
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?
Not overwhelmed
1
2
3
4
Extremely Overwhelmed
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)
Childcare
Household tasks (e.g., cleaning, light house tasks )
Emotional support
Mental Health Support
Organizing
Bedtime Routines/Family Schedule
Postpartum Support
Other
If other, please specify.
How often would you need assistance?
One-time assistance
Weekly
Bi-weekly
Monthly
What time of day do you typically need the most support?( We serve between the hours of 10am-7pm)
Morning
Afternoon
Evening
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?
Yes
No
Additional Information
Have you received assistance from “Mama Needs a Hand” or similar services in the past?
Yes
No
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?
Demographics
What is your age?
Under 18
18–24
25–34
35–44
45+
Prefer not to answer
What is your current relationship status?
Single
Married
Domestic Partnership
Divorced
Widowed
Prefer not to answer
What is your approximate annual household income?
Under $25,000
$25,000–$49,999
$50,000–$74,999
$75,000–$99,999
$100,000+
Prefer not to answer
Do you currently receive any of the following benefits? (Select all that apply.)
WIC
SNAP/Food Assistance
Medicaid
TANF
Housing Assistance
Other Public Assistance
None
Prefer not to answer
Do you identify as any of the following? (Select all that apply.)
Military Family
Parent of a Child with Special Needs
First-Time Parent
Grandparent Raising Grandchildren
Foster Parent
Adoptive Parent
None of the Above
Prefer not to answer
How did you hear about this service?
Instagram
Threads
Facebook
Family member or Friend
Local assistance program
District 7
Community on the Frontline
Other
Consent and Agreement
Signature
*
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