• Spokane Shades of Wellness Pilot Program - Eligibility Form

  • Eligibility for the Family Wellness Support Pilot is designed to remain flexible, family-centered, and responsive to real-life circumstances affecting pregnancy and postpartum wellness.

    Participants must:

    • Be pregnant or up to 12 months postpartum
    • Reside in Spokane County or surrounding service areas
    • Demonstrate a need for wellness support, family stabilization services, or additional community-based resources during pregnancy or postpartum recovery

    Special consideration and flexibility may be provided for families experiencing:

    • High-risk pregnancies
    • Premature birth
    • Pregnancy loss
    • Delayed prenatal or postpartum care
    • Infant medical complexities
    • Increased family or emotional stressors

    Eligibility is based on self-identification, wellness needs, and family circumstances rather than rigid financial thresholds alone. Self-attestation may be accepted when formal documentation is limited or unavailable.

    Participants are highly encouraged to engage in monthly wellness activities, peer support opportunities, educational workshops, leadership development, counseling support, and other approved wellness-related programming throughout the duration of the pilot.

    The enrollment process is intended to create a supportive foundation where families feel welcomed, respected, connected, and empowered throughout their participation in the program.

  • Format: (000) 000-0000.
  • What is your Ethnicity?*
  • Are you connect with any community partners*
  • Are you currently experiencing any of the following challenges? (Check all that apply)*
  • Have you recently experienced any of the following? (Check all that apply)*
  • Should be Empty: