COMMUNITY CARE GRANT (CCG) REQUEST FORM

Childbirth Collective Community Care Grant (CCG) Request Form

(Choose from English or Spanish Form in upper right corner || Elija entre el formato en inglés o español en la esquina superior derecha.)
Welcome, and thank you for your interest in a Childbirth Collective Community Care Grant! Please read our CCG Info Page, which includes important eligibility details and FAQs.

This grant program is designed to serve Minnesota families by sustaining pro bono or deeply discounted perinatal doula support with a focus on dignity, resilience, and partnership across communities. It is funded by generous community donors!

Everyone who meets the eligibility criteria described on our CCG Info Page and on page 3 of this form is welcome to submit a request for funding! The Childbirth Collective honors the leadership of BIPOC doulas and multilingual caregivers who have long carried birthwork forward, and we especially encourage those coming from historically marginalized populations to submit a grant request.
CCG Pilot Funding Cycle
- Your Services Rendered: December 1, 2025 - February 28, 2026
- Request Form Available: March 9–22, 2026
- Grant Amount: $500
- Grant Disbursement to Approved Requestors: by March 31, 2026

Grant Requestor Information
Name:*

First NameLast Name
Email Address:*
example@example.com
Full Mailing Address*:

Street Address (*mailing address field is optional; however, if you are selected for a grant and would like a printed disbursement check sent to you, a mailing address is required)

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about this grant?*
Business web site or professional profile; OR, if you do not have an online presence, please give a brief description of your experience as a doula (ex: I've supported dozens of postpartum families as a doula since 2018):*

Grant Requestor Eligibility
Attestation to Eligibility

Affirm and attest that you meet all of the following eligibility criteria by checking the box below.
- You are a birth or postpartum doula who has provided pro bono or deeply discounted services in Minnesota during this funding cycle (December 1, 2025-February 28, 2026).
- You served pregnant, birthing, and/or postpartum individuals in Minnesota who face barriers to access related to recent federal enforcement actions in the state.
- You have experienced indirect or out of pocket costs or capacity strain associated with this work. Examples include, but are not limited to:
  - Transportation and travel
  - Supplies, equipment, or materials used in care
  - Childcare or family care costs incurred while providing care
  - Administrative, communication, or coordination costs
  - Lost billable opportunities
  - General resource strain
YES
*If you are unable to affirm and attest to all of the above, please email info@childbirthcollective.org for potential future grant funding.

Additional Information
In compliance with our 501c3 status, we must be able to demonstrate that the funds we grant to individuals ultimately furthers the public good rather than private, individual benefit.

Your answers to the questions below will be aggregated with other applicants' to demonstrate the public good purpose of this grant program. Your individual answers will be kept securely in our encrypted application system, and they won't be shared with any outside parties for any reason.

Your answers below do not impact funding selection.
Birth Doula Services (incl prenatal visits, birth attendance, and postpartum visits)Postpartum Doula Services
Approximately how many clients/families did you serve during this funding cycle (December 1, 2025 - February 28, 2026)?*
Minnesota County(ies) where you provided care during this funding cycle (December 1, 2025 - February 28, 2026):*
Support Description: Briefly describe how the support you provided benefited the family(ies). Do not include any identifying information about the client/family:*
Transportation and travelSupplies, equipment, or materials used in careChildcare or family care costs incurred while providing careAdministrative, communication, or coordination costsLost billable opportunities orGeneral resource strain

Requestor Attestation & Signature
I attest that all information provided in this request form is true, and that any/all grant funds awarded will be used in alignment with the purpose of offsetting the out-of-pocket and indirect costs associated with providing pro bono or deeply-discounted community perinatal support.

I understand that this grant is designed to contribute toward the sustainability of my pro bono or discounted services and does not constitute a contract for services, wages, or payment for labor. As such, no employer-employee or agency relationship is inferred.

I recognize that grants are taxable income, and I understand that it is my responsibility to seek information on my personal reporting requirements.
Signature (use finger or mouse):*

Clear
Date:*

MonthDayYear
Date
Grant Disbursement Details
Check Mailed to My Home AddressPayPay electronic payment to your provided email address
Thank you for requesting a CCG! You will be notified if you will receive grant funds via email by 3/31/2026. Questions? Please contact: info@childbirthcollective.org
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Childbirth Collective Community Care Grant (CCG) Request Form