APPLY

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WHO IS ELIGIBLE

  • Must be female, age 16 or older.

  • Must be a U.S. Citizen

  • Must have loss of one or more limbs.

  • Must fill out the application in its entirety.

  • Must have exhausted all insurance funding resources.

  • Must be presently wearing an arm (passive) or leg prosthesis on a daily basis or be in the process of being fitted by a certified prosthetist.

  • Must be able to travel to Dallas, Texas for a 2-3 day appointment with our provider.

 

APPLICATION

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Name (First, Middle, Last) *
Name (First, Middle, Last)
Date of Birth
Date of Birth
Address
Address
Marital Status
When did you lose your limb(s)?
When did you lose your limb(s)?
 

To complete your application process, please email the following photos to info@lskfoundation.com:

1. A photo of you wearing your prosthesis

2. A close up photo/s of your prosthesis