GRACE Pregnancy Program Application Full Name * First Name Last Name Age * School Attending * Grade * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * 1. Why are you interested in joining the G.R.A.C.E pregnancy program? * 2. How far along are you in your pregnancy? * 3. What are your goals and aspirations for yourself and your baby during this pregnancy and beyond? * 4. What challenges do you anticipate facing as a pregnant teen, and how do you believe this program can support you in overcoming them? * 5. Have you received any prenatal care or education thus far? If yes, please provide details. * 6. Are you currently attending school or pursuing any educational opportunities? If yes, please provide details. * 7. Do you have a support system in place (family, friends, etc.)? If yes, please describe the level of support you receive. * 8. Are there any specific areas of support or education you are seeking from the GRACE program? (e.g., prenatal health, parenting skills, financial assistance, emotional support, etc. * 9. Is there any additional information you would like to share about yourself or your circumstances that you believe is relevant to your application? * * By submitting this application, I confirm that the information provided is true and accurate to the best of my knowledge. I understand that the selection process is competitive, and completion of this application does not guarantee acceptance into the GRACE pregnancy program. Signature of Teen * Signature of Parent or Guardian * Date * MM DD YYYY Thank you for your submission! Someone from our team will contact you soon.
