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Predator's Love

VISION ASSISTANCE REQUEST

The Westmont Lions and all Lions are known for the vision programs and service projects. As one of our core mission programs, we have worked hard within the community to provide free screenings at local events and offer a free exam and glasses voucher program to qualifying requests. To qualify, please fill in the required assistance request form, all information must be submitted to validate qualification requirements. Once submitted, a member will review the assistance request and reach out with a determination within 48 to 72 hours.

WESTMONT LIONS' VISION ASSISTANCE REQUEST

Please note that all applicants must be 18 to apply.

Birthday
Month
Day
Year
Sex
Are you currently working?
If NO, are you DISABLED?
Student?

If you have insurance, you must go through your insurance prior to requesting assistance from the Westmont Lions.

Do you have Medical Insurance? Check all that apply.

Monthly Income

Monthly Expenses

Please note that this process may take up to 2 weeks to review and process. All income and expenses must be listed; any blank or incomplete lines will not be processed for review.

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The above information is true to the best of my knowledge.

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