Prosthetic Limb Application | Standing With Hope

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To apply for a prosthetic limb, please fill out this form.

First Name*
Last Name*
Email*
Phone Number*
Gender*
Age*
Mailing Address*
City*
State/Region*
Country*
Postal Code
Type of Amputation*
Shoe Size*
Side of body*
How did you lose your limb?*
Comments
This field is for validation purposes and should be left unchanged.

Standing With Hope, Inc.

PO BOX 250 McAllister,
MT 59740

If you love someone, you’ll be a caregiver. If you live long enough, you’ll need one. Through our caregiver outreach, we’re helping those who help.

Peter Rosenberger

Founder, Standing With Hope

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Sponsor a new patient

Sponsor Godfrey

Godfrey (who lives in Kenya) sadly lost his wife in 2020. Only months later he did lost his leg above the knee. You can be a part of equipping Godfrey to Stand With Hope

Support Godfrey

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Maintained By Arjun Kushwah