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WHEN COMPLETED-‐ Please email this form back to [email protected]
MAKE A VETERAN SMILE PROGRAM APPLICATION Are You Eligible? To be considered for financial aid and other services from the Coalition, applicants must meet the following minimum eligibility requirements: • An injury sustained during combat in Operation Iraqi Freedom or
Operation Enduring Freedom, Operation New Dawn or in support of those operations in a hostile environment;
• A disability rating assigned by the Department of Defense or the Department of Veterans Affairs of 30 percent or greater from a single, sustained injury;
• Currently experiencing severe financial hardship; • Located within 200 miles of Annapolis, MD where the treatments
would take place. • Completion of a Coalition to Salute America’s Heroes aid application
and timely submission of supporting documentation as requested; and
IF YOU MEET THE ABOVE, Please complete the following, and e mail with photo to [email protected] Name: Address: Gender: Age: Military service history (OIF/OEF/OND/ongoing, dates of entry & discharge):
WHEN COMPLETED-‐ Please email this form back to [email protected]
Are you in need of a plastic procedure? Have you considered or received plastic surgery through the VA or charitable organization? What would receiving a complimentary plastic surgery procedure mean to you? To your family? In addition we ask you to upload photos of your injury with this application. We may request your DD214 or any other relevant paperwork as the application process continues.
