Weight Loss Surgery Foundation of America

Saving lives one grant at a time

How To Apply For A Grant

Grant Applications from referred patients will be accepted from
June 1, 2014 – December 2014

Step 1) To apply for a WLSFA Grant you must be referred to us by a qualified surgeon.
Step 2) Once referred you may submit an application to the WLSFA along with your referral to be considered for funding.

*Qualified surgeons can refer patients in need. Referred patients may submit a completed application packet to the WLSFA by mail on or before December 31, 2014
*Qualified surgeons are US Bariatric Surgeons that are ASMBS Center of Excellence Certified & members of FACS or have ACS BSCN Accreditation & members of FACS.
US Plastic Surgeon who are that are Board Certified by the American Board of Plastic Surgeons ABPS and members of the American Society of Plastic Surgeons ASPS

Who is Qualified to Refer Patients for a Grant?


Doctors must refer you using the WLSFA Referral form. A referral letter from the Doctors office is not accepted.
If you are a qualified surgeon:
Please send an email to Send Email to request a password to our secure online Referral Form.

If you are a patient:
Access the Referral Guidelines and application forms CLICK HERE

The referral process is on line and secure. Your surgeon will request a password via email and they can complete their referral form on line. Referring doctors will be required to print a copy of the referral to give to the applicant to include in their application packet.

Watch the Video About How the Grant Referral Program is Set Up

To Help You Prepare

All referred applicants must be 18 years old or older and will be asked to provide the following required information with their grant application:
· A letter of referral from your surgeons office via the WLSFA Online Referral Form
· Completed Application Forms
· Completed Financial Questionnaire
· If Insured: Verification of insurance denial – including appeal
· Verification of personal loan denial from three different sources
· Verification of public assistance denial ( Medicaid, Medicare, State Programs) (If quailified for these programs)
· Contact information for two character references ( Name, Phone, Email Address) – Not family members
All applicants must answer the following questions:
· Agree to raise 10% of the funds required for your grant? (The WLSFA will assist in the fundraiser)
· Willing to be an Ambassador for the WLSFA? Appear on Television, Radio, Print and On -Line
· For Weight Loss Surgery Only – Agree to attend support group provided or recommended by your surgeon for one year

The Selection Process:
The selection committee bases it’s decisions on financial hardship and patient effort only.
All required information must be submitted with the application including an essay. The essay can be up to five type written pages telling your story. This essay helps the selection committee determine who is most deserving. The Blinded grant application (the applicants name and contact information is removed) along with the surgeons referral is reviewed by the selection committee who selects the finalists. The board of directors of the WLSFA choose the actual grant recipients from the finalists for each grant cycle. The number of grants awarded is based on the funds raised in that grant cycle. There is no guarantee any grants will be awarded.

Links to help you prepare:
How to Appeal an Insurance Denial
How to apply for Medicare Medicaid or State Programs
Find a Bariatric Surgeon
Find a Plastic Surgeon



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