Apply For Assistance

Application and Medical Eligibility Requirements.

Disclaimer: By completing this application, the applicant (or parent or legal guardian on behalf of a minor child applicant confirms the waiver and liability release has been received, reviewed, and signed. The applicant further acknowledges that, in order to participate in the Dysphagia Outreach Project, the applicant must reside in the United States or its designated territories and have had a medical appointment within the last three (3) months. Eligibility for assistance may be limited based on financial need generally determined using the recipient's home state Medicaid eligibility requirements.
Name, Relationship, Address, Email, and Phone #
Please include full name, business address, and phone #
Example: Stroke, Multiple Sclerosis, ALS, Down's Syndrome, Premature Birth, Failure to Thrive, etc....
Click or drag a file to this area to upload.
(Failure to include instrumental swallow evaluation [MBSS/FEES] may result in delayed application processing.)
(Proof of income is required.)
Click or drag files to this area to upload. You can upload up to 5 files.
(Failure to include proof of income may result in delayed application processing.)
Select all that you are requesting
(attaching treating doctors order/prescription, if available in next space)
Click or drag a file to this area to upload.
* I acknowledge that I understand how to contact The Dysphagia Outreach Project with questions, concerns, or to request more supplies.

For anyone with swallowing disorders,
we can provide assistance.

Simply follow three steps to get help
with your swallowing needs today.

Some of the great sponsors participating in the Dysphagia Outreach Project

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Every dime goes to our recipients

Here at The Dysphagia Outreach Project, no single person within the organization - from the founders to the occasional volunteer - is paid anything. We are a 100% volunteer-based organization. Any donations that come to us go straight to our recipients or to keep the lights on! We are always looking for individuals willing to donate their time to help keep our operations running smoothly.

Learn More about Dypshagia Outreach Project >>

Dysphagia Outreach Projects is here to help throughout the process!

Apply On Our Website

In order to be considered as a recipient of The Dysphagia Outreach Project’s Dysphagia Food Bank, the following criteria must be met:

  • Completion and submission of all documents as required in our application packet including:
    1. Our ONLINE recipient application
    2. ONLINE signature of our waiver of liability, which will be emailed to you upon receipt of the online application.
  • Demonstration of financial need. This may be either a statement of current income or a statement of extenuating circumstance (life happens).
  • Current supervision of care by a Medical Doctor with an active diagnosis of dysphagia
  • Documentation indicating completion of an instrumental dysphagia assessment within the past 3 months (or explanation as to why this was unable to be completed)
  • Supervision of care by a licensed Speech-Language Pathologist
  • Inability to complete the application in full or demonstrate need may result in denial of participation in our food bank program.

Any questions regarding the application process or criterion for acceptance into the program can be submitted to team@dysphagiaoutreach.org.


Get Approved & Join Our Community

Our mission at The Dysphagia Outreach Project is twofold.

Part one is to help provide assistance for those individuals for whom accessibility of dysphagia supplies is limited due to financial hardship.

The other part of our mission is to provide education and support to the dysphagia community at large about when it is appropriate to recommend and utilize these same supplies.

Request Order & Get Products!

Since dysphagia affects individuals at any age, our goal is to advocate for support and awareness of issues related to dysphagia across the lifespan. We also aim to improve interdisciplinary team-building and cooperation to ensure that individuals with dysphagia, their family/caregivers, and their care team are all educated regarding evidence-based practice in swallowing and swallowing disorders.