paternal health Apply to get help in building a game plan for you to champion the health of your family. Apply Items & documentation Items needed * Diapers and Wipes Stroller Car Seat Playpen Access to resources across Chicago Financial Support for Baby Shower Note: Financial Support for Baby Shower is limited to $250 and funds are limited Please select at least one item Father's information First name * Please enter father's first name Last name * Please enter father's last name Date of birth * (MM/DD/YYYY) Please enter a valid date (MM/DD/YYYY) Phone * Please enter a valid phone number Email * Please enter a valid email address Address * Please enter your address City * Please enter your city State * Please enter your state Zip * Please enter your zip/postal code United States Canada Mexico United Kingdom Australia France Germany Japan China India Brazil South Africa Spain Italy Netherlands Sweden Switzerland New Zealand Other Country * Please select your country Are you employed? * Yes No Please select whether you are employed Less than high school High school diploma or GED Some college College degree or higher Highest level of education * Please select your education level New Father Expecting Father Father status * Please select your father status Baby's date of birth/Due date * (MM/DD/YYYY) Please enter baby's date of birth or due date Social media handles/links Mother's information Important: Mothers must be past 24 weeks pregnant to be eligible for this program. First name * Please enter mother's first name Last name * Please enter mother's last name Date of birth * (MM/DD/YYYY) Please enter a valid date (MM/DD/YYYY) Phone * Please enter a valid phone number Address * Please enter your address City * Please enter your city State * Please enter your state Zip * Please enter your zip/postal code Country * Please enter your country Are you employed? * Yes No Please select whether you are employed Less than high school High school diploma or GED Some college College degree or higher Highest level of education * Please select your education level Are you past 24 weeks pregnant? * Yes No You must be past 24 weeks pregnant to be eligible Baby's date of birth/Due date * (MM/DD/YYYY) Please enter baby's date of birth or due date Hospital Primary doctor I agree to the terms and conditions * You must agree to the terms Submit application Thank you for your application! We have received your program application and will contact you soon.
