It's the policy of Healthy Mothers, Healthy Babies that monetary assistance is not given directly to mentee's, but paid directly to a vendor, business, school, etc. This form is only a request and does not guarantee its approval.

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* 1. Name of Person Making the Request (First and Last)

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* 2. Please describe in detail what is needed and when it's needed by. Include costs and if applicable, sizes, quantity, links to product(s), etc.
Keep in mind that requests can take up to 2 weeks to process.

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* 3. What's the best way to reach you regarding this request? Please include contact information.

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