The Reproductive Health (RH) Access Fund Form

The Reproductive Health (RH) Access Fund pays for birth control and medical services related to reproductive health. We do not discriminate. You can get services no matter your citizenship, immigration, documentation status, or gender identity. Please fill out this form to help us decide if you qualify for these services. This information is kept as private as possible.

To learn more you can download the following brochures:

Pathways to Care explains how to access reproductive health care services.
Reproductive Health Client Brochure is an overview of the program and is available in both English and Spanish.

The enrollment form is downloadable in the following languages:

Please bring the following documentation when you enroll:

Your US passport OR
Your birth certificate and photo ID (Don’t have your birth certificate? We can help you obtain a free original birth certificate) OR
Your eligible immigration documentation and photo ID. *Click here to see what type of documentation is acceptable by the program. Click Here to see documentation samples.
Your social security number
If you are not a US Citizen or have eligible immigration status, you do NOT need to bring in any documentation.
Your completed RH Program application.