Important Requirements and Guidelines:

• To qualify, you must be between 1 - 14 weeks pregnant at the time that you submit your application.
• You must submit a proof of pregnancy document with your application that includes the following information:
  • Patient Name
  • Date of Your Visit to your Medical Provider
  • Expected Due Date
  • Health Care Provider’s Signature
  • Clinic’s Name, Location, Contact Information
• Share this letter with your healthcare provider to insure accurate information is included

See accepted counties here.