Funding Application

Mending Limbs Organization will only provide financial assistance for individuals that do not have insurance, no government assisted funding or supplemental assistance. Applications will be reviewed by the Board of Directors and applicant will be selected based on available funds.
We are currently only accepting applications for the state of Tennessee.

First Name
Last Name
Street Address
City
State
Zip Code
Email Address
Are you a US Citizen?
Please provide us with your Health Care provider's name, address, and contact information.
Health Care Information
In a minimum of 1,000 words, please explain in detail exact reasons why your Health Insurance Provider will not cover your prosthesis.
Tell us your story…