Reproductive Grief Care Education Application

Reproductive Grief Care Education Application
Thanks to the generosity of our donors, select organizations and individuals can receive Reproductive Grief Care education at no cost.

Build your team’s expertise. Strengthen patient care. Become a leader in compassionate, evidence-based Reproductive Grief Care.

Funding is limited. Applications are competitive.

Organizations operating within the United States that fit one or more of the following criteria are eligible to apply:
- Federally Qualified Health Centers (FQHCs): Outpatient clinics and community-based health providers that receive federal funding to treat medically underserved areas and populations.
- Organizations that offers medical services, in combination with mental health counseling, health education, support groups, or other support opportunities.
- Smaller organizations with under 250 staff members.
Please complete the application below to help us further determine your eligibility. You may submit the application more than once to indicate interest in multiple opportunities. Email Sara Dominguez at sara@reproductivegrief.org with any additonal questions.
Name

First NameLast Name
Email
example@example.com
Which Pathway Are You Interested In?
Reproductive Grief Care Professional Standard Designation Application
More about the program: .

What is it? Education program with coaching, live training, and ongoing education for the entire organization to learn a comprehensive approach to compassionate reproductive grief care. Informed by current, relevant research and proven practices that will have far-reaching impacts on individuals’ healing trajectories and staff resiliency.

Why You? Don’t miss the opportunity to transform your organization into a leader in compassionate, evidence-based care for those facing reproductive loss. This program empowers you to improve client outcomes, tackle grief and mental health challenges, and fortify your team with tools to prevent burnout and compassion fatigue.

Earning the prestigious Reproductive Grief Care Professional Standard Designation sets your organization apart as a trusted, go-to resource in trauma-informed care, boosting your credibility and impact in your community.

This exclusive designation will be awarded to organizations that complete the following workflow:
Participating organizations must identify an internal Project Lead to support this project.

A Project Lead should be:
- Someone whose expertise/authority spans both clinical and operational realms (i.e. nurse/mental health manager, nurse navigator, clinical supervisor, nurse/mental health educator, perinatal bereavement coordinator, etc.)
- Someone who has the authority and ability to make team-wide scheduling decisions and is able to ensure the project stays on-pace
- Someone who has the authority and support of executive leadership to influence clinic policies and procedures in order to implement compassionate reproductive grief care practices on an organizational level
- Note: Project Lead selection should be internally evaluated while filling out this application, and must be finalized before attending the Kick-Off Orientation Call.
Project Lead Name

First NameLast Name
Project Lead Title
Project Lead Email
example@example.com
# of Affiliated Groups or Locations
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Organization Name
Address of Organization

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
State
Zip Code
Organization Details
How many licensed nurses does your organization have?
How many licensed MD/PAs does your organization have?
How many licensed mental health professionals does your organization have?
How many support staff team members does your organization have?
Total number of client-facing staff and volunteers across the organization
Client-facing staff and volunteers includes any role that has significant, clinic-sanctioned interaction with clients/patients (e.g. receptionist, nurse, client advocate, bereavement coordinator, parenting program coordinator, ultrasound tech, social worker, etc.)
What is the number of patients/clients seen by your organization monthly?
Additional Comments
Application Questions
Please describe why you wish to earn the Reproductive Grief Care Professional Standard Designation.
Please describe how you plan to use the information gained.
Have you provided reproductive grief care or perinatal bereavement education for staff in the past 3 to 5 years? If so, please describe what education was provided, how it was administers, and who received the education. Is it part of onboarding?
What process do you use to identify practice gaps and the underlying educational needs (knowledge, skills, and/or practices) that contribute to those gap(s)? (e.g. annual needs assessment survey, client/patient feedback surveys, new approaches, staff requests/feedback)
What are the challenges that staff encounter when they provide support to those experiencing a pregnancy loss?
What support services are currently offered at the time of, and after, a reproductive loss?
Have you applied for this grant opportunity before?
To confirm your grant eligibility please fill out the following:
I understand that the Project Lead is responsible for attending 4, 1-hour coaching sessions, coordinating staff schedules for on-demand courses and scheduling the Multidisciplinary Practice with our team and theirs.
If selected, I agree to move my team through the program in its entirety within the designated timeframe of 6 months; otherwise, I understand that my organization’s spot may be forfeited.
If selected, is the Project Lead available to attend a Zoom kickoff call.
Certificate Bundle Application
Designed for medical professionals, mental health clinicians, and those supporting others in their communities, each certificate provides role-specific training to confidently support individuals experiencing reproductive loss.

We recommend teams of 5–15 participants to foster shared learning, strengthen team-wide understanding of reproductive grief care, and support the integration of compassionate, evidence-based practices across your organization.
Organization Name
Organization Address

Street Address

Street Address Line 2

CityState

Zip Code
How many members in your team are interested in earning their certificate?

Fill out the numbers below.
Medical Professionals
Physicians, nurses, midwives, emergency department clinicians, and medical trainees
Mental Health Professionals
Therapists, counselors, psychologists, and social workers
Individual Professionals
Laypeople, support staff, nonprofit leaders, HR professionals, advocates, and community members
Please describe why you wish to earn the Reproductive Grief Care Certificate for your team.
Please describe how you plan to use the information gained.
What are the challenges that staff encounter when they provide support to those experiencing a pregnancy loss?
What support services are currently offered at the time of, and after, a reproductive loss?
I understand that complimentary kickoff and wrap-up calls are reserved for teams of 5 or more.
Symposium Scholarship Application
The Institute's 2027 Annual Symposium, The Emotional Emergency: Reproductive Loss Beyond the Medical Moment, brings together healthcare professionals, researchers, and community leaders to advance compassionate, whole-person reproductive grief care. Through evidence-based education, lived experiences, and interdisciplinary perspectives, participants will explore ways to recognize emotional needs beyond medical stabilization and strengthen trauma-informed support across clinical, mental health, and community settings. Click here to visit our website and learn more about this educational event.

A limited number of scholarships covering registration fees are available to students and professionals seeking to participate in the Symposium virtually on April 9th, 2027 from 8:00 a.m. to 5:00 p.m. Pacific Time. Please fill out the information below to aid us in determining eligibility.
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
I am a
Academic Institution
Enrolled Program
Anticipated Graduation Date
Affiliation (organization, academic institution, business)
Title and/or Profession
Address

Street Address

Street Address Line 2

CityState

Zip Code
Please describe why you wish to attend the Symposium (up to 100 words)

0/100
Please describe how you plan to use the information gained at the Symposium (up to 100 words)

0/100
How did you hear about the Symposium?
If awarded a scholarship, I will attend the virtual Symposium in its entirety (8am-5pm PST, Friday, April 9th) and complete the required evaluation form.
Should be Empty:

Reproductive Grief Care Education Application

Reproductive Grief Care Professional Standard Designation Application

Organization Details

Application Questions

Certificate Bundle Application

How many members in your team are interested in earning their certificate?

Symposium Scholarship Application