BCB Grant/Scholarship Application Form

Program Overview

Breastfeeding is so important for both babies and parents. At Bayou City Breastfeeding, we believe that every family should have the chance to get expert support during this special time. We know that sometimes insurance doesn't cover everything, or some families might not have insurance.
In 2021, we started a program to help out. We've been setting aside funds, and up to now, we've given over $60,000 to help families just like yours.

These funds help cover some of the costs of lactation support for families who need it.

Who Can Apply?

Any family who needs financial help and doesn't have insurance coverage for our services is welcome to apply.

Things to Know Before Applying:

We go by the order we get applications, until we run out of funds for the month.
Once you get the grant, it'll cover part of the cost. Families will need to pay at least $75, but if you can pay a bit more, it helps us assist others too.
No need to show us your income, but we hope you'll pay what you can. This lets us help even more families.
The grant can be used for most visits, but not for home visits or if you have to cancel last minute.
You can have your appointment in our office or virtually. We don't offer home visits for grant recipients.
When you book, you'll need a credit card to cover your part of the visit.
If you can't make your appointment, let us know 48 hours in advance. If not, there's a $100 fee. If you miss without telling us, you'll have to pay the full visit fee and you will no longer be eligable for the grant.
If you reschedule your initial visit more than once, you will no longer be eligable for the grant and will be charged our discounted cash pay price for your visit.
The grant covers two visits. Once approved, you have 7 days to schedule the initial visit or the funds will be returned to the grant and you will have to reapply. Additionally, both visits must be used within 30 days of the initial visit, or the funds will be returned to the grant.
Sometimes, if our expert thinks it's needed, you can get one more visit. For this, you'll pay our discounted cash pay prices.

How is the Grant Funded?

Every month, we put at least $500 in the grant fund. Sometimes, we add a bit more. Anyone can donate to help out, but just so you know, it's not tax-deductible. At the end of each year, we let all donors and families know how things went.

Want to donate and help a family? Click here to donate now

Ready to apply? Just fill out the form below.

Grant Application

Parent's First Name

Parent's Last Name

Parent's Date of Birth

Email address

Street Address

City

State

Zip Code

Cell Phone Number

Baby's Name

Baby's Date of Birth or Due Date

Photo of Parent's Insurance Card (Front and back)

Add file

Please upload a file

Photo of Child's Insurance Card (Front and back)

Add file

Please upload a file

Please tell us about your situation and why you are applying for the grant:

To help as many families as possible, we kindly ask that you pay what you can for each visit.

Our special rates, if you pay promptly (cash pay), are:

Prenatal (Office) Visit: $175.00
Initial Postpartum (Office) Visit: $225
Follow-up (Office) Visit: $175
Frenotomy Support Visit: $175
Virtual Visit: $125

If you've gotten a grant from us before, you can ask for one more office visit if your IBCLC thinks it's needed. You'd pay $100, and the grant can cover the remaining $75, as long as funds are available.

Rules and consents

Please select each of the following checkboxes to indicate that you have read and agree to the following policies regarding your grant visit request.

I understand and agree that my grant visits will be subject to the standard Bayou City Breastfeeding cancellation policy.

I understand and agree that grant funds may not be used for home visits or cancellation fees.

I understand and agree to pay the portion of the visit fees not covered by the grant.

I understand and agree to provide a credt or debit card to schedule my visit and this card will be used to pay the portion of the visit fees not covered by the grant on the same day as my grant visit.

I understand that if I fail to pay my portion of the grant within 24 hours, I will no longer be eligable for the grant and will be responsible for the full visit fee.

I give consent for Bayou City Breastfeeding to contact me regarding my Grant Application.

I understand that I must schedule my initial grant visit within 7 days of approval

I understand that if I will be charged $100 if I cancel my visit with less than 48 hours notice.

Name for Signature

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BCB Grant/Scholarship Application Form

Program Overview

Grant Application

Rules and consents

Bayou City Breastfeeding LLC