Prosthetic Grant Questionnaire

The Given Limb Foundation does not discriminate based on race, sex, religion, age, sexual orientation, or physical disability. However, the Foundation has limited resources and makes only a few grants of this type each year (and, at this time, only to US citizens or permanent residents). Priority is based on a number of factors including financial need and how the grant will impact the applicant’s quality of life.  The following questions are designed to obtain this information, but the answers are used strictly for grant-making purposes and are kept in strict confidence.

Fields marked with an asterisk * are required.