The Baby Sleep Site™ Reduced Fee Program Survey

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* 2. What is your email address? PLEASE NOTE: We often have trouble getting through to hotmail.com email addresses. Please consider using another email service for us to reach you.

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* 3. How old is/are your baby/babies who brought you to The Baby Sleep Site? (Choose all that apply and use current age)

3 months or younger

4 to 6 months

7 to 9 months

10 to 12 months

13-18 months

19-23 months

2 years or older

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* 4. What are your current sleep challenges? (Just a brief description)

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* 5. Please tell us a bit about why you are applying for one of reduced fee Basic Sleep Email Consultation Plans?

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* 6. How much are you willing to pay for a Basic Email Sleep Consultation Package? (Please note that the minimum amount is at least $25)

$25

$30

$35

$40

$45

$50

Other (please specify)

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* 7. Under different circumstances or if you were able to afford a consultation package at full price, would you purchase one?

Yes, absolutely!

Yes, I think so.

Maybe, I'm not sure.

No, too expensive.

Other (please specify)

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* 8. To qualify for the assistance program, you will need to submit one proof of hardship. Please indicate below which type of proof you will be submitting. (All proof must not be more than 3 months old) NOTE: A scanned copy of your proof of hardship can be emailed to contact@babysleepsite.com.

SSI (Supplemental Security Income)

TANF (Temporary Assistance for Needy Families)

EBT (Electronic Benefit)

WIC (Women, Infant and Children)

Free/ Reduced lunch program

Unemployment Benefits/Award Letter

Paycheck stub

Disconnection or past due notice for utility

Proof of enrollment in a low income/subsidy program

Section 8 Housing

Other proof of additional financial benefits or support

Letter of certification from a local community based program

Proof of total gross household income or proof of low-income status

Statement of need from clergy, employer, or other qualified individual who is aware of current financial status.

Other (please specify)

The Baby Sleep Site™ Reduced Fee Program

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* 1. What is your full name?

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* 2. What is your email address? PLEASE NOTE: We often have trouble getting through to hotmail.com email addresses. Please consider using another email service for us to reach you.

Question Title

* 3. How old is/are your baby/babies who brought you to The Baby Sleep Site? (Choose all that apply and use current age)

Question Title

* 4. What are your current sleep challenges? (Just a brief description)

Question Title

* 5. Please tell us a bit about why you are applying for one of reduced fee Basic Sleep Email Consultation Plans?

Question Title

* 6. How much are you willing to pay for a Basic Email Sleep Consultation Package? (Please note that the minimum amount is at least $25)

Question Title

* 7. Under different circumstances or if you were able to afford a consultation package at full price, would you purchase one?

Question Title

* 8. To qualify for the assistance program, you will need to submit one proof of hardship. Please indicate below which type of proof you will be submitting. (All proof must not be more than 3 months old) NOTE: A scanned copy of your proof of hardship can be emailed to contact@babysleepsite.com.

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* 9. What is your annual household income? Use last year's tax return or estimate for this year.

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* 10. What is your family size? (each person should live in your home)

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* 1. What is your full name?

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* 2. What is your email address? *PLEASE NOTE: We often have trouble getting through to hotmail.com email addresses. Please consider using another email service for us to reach you.*

Question Title

* 3. How old is/are your baby/babies who brought you to The Baby Sleep Site? (Choose all that apply and use current age)

Question Title

* 4. What are your current sleep challenges? (Just a brief description)

Question Title

* 5. Please tell us a bit about why you are applying for one of reduced fee Basic Sleep Email Consultation Plans?

Question Title

* 6. How much are you willing to pay for a Basic Email Sleep Consultation Package? (Please note that the minimum amount is at least $25)

Question Title

* 7. Under different circumstances or if you were able to afford a consultation package at full price, would you purchase one?

Question Title

* 8. To qualify for the assistance program, you will need to submit one proof of hardship. Please indicate below which type of proof you will be submitting. (All proof must not be more than 3 months old) NOTE: A scanned copy of your proof of hardship can be emailed to contact@babysleepsite.com.

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* 9. What is your annual household income? Use last year's tax return or estimate for this year.

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* 10. What is your family size? (each person should live in your home)

* 2. What is your email address? PLEASE NOTE: We often have trouble getting through to hotmail.com email addresses. Please consider using another email service for us to reach you.