SEAMMS Foundation Application Form

Your Child's Personal Information
  • Child's Gender

Parents/Guardian Contact Information

Please indicate Address information if different from the child's address

Hospital Information
Finalcial Information
  • Does Your Family Live Below the Federal Poverty Line?

  • If Yes, Please Mail us Copy of the Statement that Show Your Current Finatial Situation.
  • Are You Eligible for Recurring Governmental Assistance? (i.e. Medical)

  • Documentation Check List
  • If You Have Income, Please Mail us the Nessesary Document(s) in LIST A
  • If You Have No Income, Please Mail us the Nessesary Document(s) in LIST B
Final Step