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Vision Care Assistance Application

About This Application

This is the official application for vision care assistance through the Your Right to See the World Fund, a program of See The World Foundation.

The program provides financial assistance for children who are unable to access essential vision care due to financial hardship. Eligible requests may include eye exams, prescription glasses, medically necessary treatments, surgeries, and other vision-related needs.

If approved, See The World Foundation pays vision providers directly for eligible services. We do not provide cash payments.

SECTION 1: CHILD INFORMATION

Child’s Full Name

Child’s Date of Birth

Child’s Age

City and State of Residence

SECTION 2: PARENT / GUARDIAN INFORMATION

Parent/Guardian Full Name

Relationship to Child

Phone Number

Email Address

SECTION 3: VISION NEED

What type of vision care is needed?

What type of vision care is needed?
A
B
C
D
E
F

Please briefly describe the child's vision condition and the care being requested.

Has a doctor or optometrist already evaluated the child?

Has a doctor or optometrist already evaluated the child?
A
B

Name of eye care provider or clinic where the child will receive care

Estimated total cost of care (if known)

How much assistance are you requesting from See The World Foundation? ($)

SECTION 4: FINANCIAL NEED

Please describe the financial challenges that make it difficult to pay for this vision care.

Is the child currently covered by health insurance?

Is the child currently covered by health insurance?
A
B
C

If the child has insurance, how much will insurance pay toward this care?

Is the family receiving financial assistance from another source for this expense? If yes, how much?

SECTION 5: DOCUMENTATION

Upload an invoice, cost estimate, prescription, or other document related to the requested vision care (if available).

This may include an invoice for glasses, a cost estimate from a provider, a prescription, treatment plan, or another document showing the vision care services being requested and their estimated cost. These documents help us verify the request and determine eligibility for assistance.

SECTION 6: AGREEMENT

Certification Statement

I certify that the information provided is accurate to the best of my knowledge. I understand that See The World Foundation does not provide cash payments and, if approved, funds will be paid directly to a vision care provider for approved services.

I certify that the information provided is accurate to the best of my knowledge. I understand that See The World Foundation does not provide cash payments and, if approved, funds will be paid directly to a vision care provider for approved services.