Healing Heroes Scholarship Program Interest

In order to be sent our official application, please acknowledge the following below. Once you have agreed to each acknowledgement, you will be redirected to verify your veteran or first responder status.

First Name *

Last Name *

Phone *

Email *

Are you Military or First Responder?

Military (Active Duty or Veteran of the U.S. Armed Forces)

First Responder (Firefighters, Law Enforcement Officers, Emergency Medical Technicians (EMT), Paramedics, Federal Agents)

Both, Military and First Responder service

Acknowledgements

Military Service acknowledgment *

I acknowledge I qualify for one of the following: Minimum of 6 years of service, OR A combat deployment, OR A service-related injury. Must be honorably discharged (if no longer active duty).

First Responder Service Acknowledgement *

I acknowledge meet one or more of the following criteria: I have served as a Firefighter, Law Enforcement Officer, Emergency Medical Technician (EMTs), Paramedic, Federal Agent for a minimum of 6 years of service, OR injured in the line of duty. Must have ended service in good standing.

Verification Process *

I understand that my information will be verified by the Miracle Hope Foundation system and through a call with a Heroes Advocate. I understand that providing false or misleading information may result in disqualification or revocation of my scholarship.

Treatment Eligibility & Deposit Acknowledgement *

I acknowledge that participants must be qualified for treatment with an approved provider. I understand that the medical provider requires a $2,500 fully refundable deposit to schedule a doctor consultation to receive an approved treatment plan.

Program Participation Acknowledgment *

If awarded a scholarship, I agree to complete all required post-treatment surveys and follow up visits as part of the Healing Heroes Scholarship program.

Financial Need Acknowledgement *

I confirm that I am applying because I have a true financial need.

Application Process and Timeline Acknowledgement *

I understand that the scholarship review and approval process may take up to 8 weeks. If my application is approved, I will be notified regarding next steps.

Privacy Rights *

I consent to the release of my confidential health information, including relevant records and details about my health status or treatment to Miracle Hope Foundation. This information is shared solely for purposes of scholarship and treatment process, research and study data collection. I understand this consent is voluntary and may be revoked in writing at any time.

Terms & Communications Consent *

Yes! I want to receive updates from MHF and agree to receive communication via email and SMS from Miracle Hope Foundation.

Once you submit this form, you’ll be redirected to our military & first responder verification form. Once verified, you will be sent our official scholarship application. Thank you!