Sign up for UPSC Support Mentor
This is a free service that UPSC is offering to the community of Long Island. Support Mentors can provide you with evidence based knowledge and support from your pregnancy to postpartum. Please note, this is a virtually based program, we do not offer in person support.
Your Email Address
Your Cell Phone Number
Your Date of Birth
What are your pronouns? (she/her, ze/zir, etc.)
Another hispanic, Latino/a, or Spanish Origin
Not of Hispanic, Latino/a, or Spanish Origin
I prefer not to answer
Black or African American
Other Pacific Islander
Guamanian or Chamorro
I prefer not to answer
Your Partner's Name (if applicable)
How did you find out about the UPSC Support Mentorship?
About Your Birth
Estimated Due Date or Date Baby was Born
What hospital are you planning to deliver at?
Who is your provider?
How many pregnancies have you had, including this one?
How many births have you had?
What else do you want us to know about this upcoming birth (is this a VBAC, any other ailments, high risk, etc?)
What, if any, specific concerns about your birth or postpartum?
Although we can't guarantee it, we will do our best to match you as best as possible with a volunteer. Please check off any preferences you have.
Someone experienced in VBACs
Someone experienced in Cesareans
Person of Color
Other (please specify next)
Once you are matched with a Support Mentor, the initial method of contact will be a text message. After that, support can continue via text, phone call, and/or video calls. Please check off your preferred method of contact.
Text & Phone
Text, Phone, & Video
Phone & Video
Text & Video
Emergency Contact Number
I certify that the above information is true and complete to the best of my knowledge. If my situation changes, I will notify UPSC as soon as possible. I understand that filling out this form does not guarantee a Support Mentor. I understand that UPSC has vetted their mentors to the best of their ability, however, I know that this is a volunteer based program and I resolve UPSC of any performance liability. I understand that if my Support Mentor feels that I am in danger, they will do the best they can to connect me with resources, but also they might use my emergency contact to help.
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