Contact

If you wish to apply for a grant to help purchase a prosthetic limb, you must fill out the Questionnaire.  Click the blue button below to access the Questionnaire.  Please note that we will not review applications until the end of each calendar quarter, and that we cannot consider any application that is incomplete..  All applications will be held and reviewed together at the end of the quarter, and you must provide all required information (including tax returns) in order to be considered.

Complete the Prosthetic Grant Questionnaire

 

 

Use the form below for all other inquiries that do NOT relate to a request for financial help with a prosthetic limb.

 

Your Name (required)

Your Email (required)

Subject

Your Message