Provale Cup – 10cc/Brown
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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.