FINANCIAL WORKSHEET

Birth Mom Information

Phone

​We can help you get a basic phone or pay your basic phone bill. We will pay this directly to the phone carrier.

Rent

Heart to Heart can help with housing assistance. We pay rent directly to the landlord. For approval, we will need a copy of your rental agreement and a receipt from your landlord.

Utilities

We can help with essential utilities. This doesn't include back payments or deposits. Bills will be paid directly to the provider. You will need to mail, photo, fax or email a copy of the entire bill.

Food/Personal items/Transportation

​We provide you with a Master Card which we load as needed,

**I understand that fraud is an intentional deception to get money. I will not accept services or financial assistance from Heart to Heart unless I am fully intending to place my baby for adoption with Heart to Heart Adoptions. I also agree that will not accept services from Heart to Heart Adoptions while receiving services from another adoption agency, perspective adoptive family, or attorney. I understand that I can be prosecuted for any fraud that I commit.**

Financial Plan - Review and complete with your Case Manger.