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Wayman L. Tisdale Foundation Inc. Application for Funding Assistance


Our Mission is to work with other organizations to identify individuals with prosthetic needs but with limited personal resources for cutting-edge prosthetic care. Realizing more than 156,000 people in the United States will experience the loss of a limb; we are committed to becoming a funding source and a resource for those in need.  Our goal is to improve the lives of our recipients one person and one family at a time. We know we can make a difference.

Application Criteria

⦁ Must fill out the application in its entirety.

⦁ Must be able to wear/operate a prosthetic device.

⦁ All information submitted in an application is strictly confidential. It will only be used for the sole purpose of the selection process.

⦁ All forms must be completed, signed, and dated. Applications with blanks or missing critical information could be eliminated from the selection process.

⦁ Upon review of all documents, WLTF may request additional information and documentation.

⦁ The application and prosthetic service provider selection will be made by the Wayman L. Tisdale Inc., Board of Trustees. The decision will be final.

Required Documentation

⦁ A description in your own words of your situation and why you need financial assistance.

⦁ Explanation of the denial from your primary and/or secondary insurance carrier

⦁ Explanation of all other funding sources that you have requested funding from, including reason for denial of funding from each.

⦁ Photos: full front, full back, residual limb

⦁ Photo / Video Release Form

Runner with Amputated Leg


⦁ It is the goal of the board to provide prosthetic limbs to a minimum of two (2) individuals per year.

⦁ An application must be submitted to the Wayman Tisdale Foundation, Inc., Board of Trustees, to receive funding for a prosthetic limb

⦁ The submission deadline date is May 1st, of each year.

⦁ The board will select the recipient(s) at the June board meeting.

⦁ The Wayman Tisdale Foundation, Inc. will provide an adult with one (1) adult prosthetic limb per lifetime.

⦁ The Wayman L. Tisdale Foundation will provide a child multiple prosthetics limb as they grow with a $10,000 lifetime maximum.

⦁ The recipient will receive funding for the prosthetic limb as well as the physical therapy and routine maintenance for the life of that prosthetic limb.

⦁ The recipient may be asked to be featured in publications such as our fund-raising brochure.

⦁ The recipient must be an Oklahoma resident.

⦁ You’ll receive a notification from the Executive Director by July 15, whether your application has been approved.

Prosthetic Application



Do you currently have a prosthetic?
Do you have medical insurance?
Have you been denied from your primary and/or secondary insurance provider?
Did you request funding from other sources? *

Photo & Video Release Form:

By signing this form I give my consent to Wayman L. Tisdale Foundation, Inc. to use any photographs, video, or any other medium taken of me for educational and/or publication purposes.

Thank you for your application. We will contact you soon!

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