Application For Assistance

Application For Assistance

We are here to help children born with cleft lip and palate find a place, seek treatment, gain support and love, and aspire to become who they want to be. The Mia Moo Fund receives hundreds of applicants, and we are motivated, dedicated and obligated to assuring that each applicant receives a response and are equal with-in the consideration process of delegation of funds.

To apply for help from the Mia Moo Fund, we require that you verify some simple information so that we can better understand your needs and offer help accordingly. Begin by filling in the information below. Please understand that as soon as your application is processed, we will notify you and contact you as soon as possible. This may take several business days due to the amount of applications we receive.

Due to both legal reasons and the amount of applications we receive, we require that the child being applied for is a direct family member and has given consent to the application. Applications may not be processed for a child unless you are the legal guardian of said child. If you have any questions, feel free to Contact Us.

Your Details








Applicants Details






Initial Treatment Information






Doctors Contact Information For Initial Treatment






Additional Treatment Information






Doctors Contact Information For Additional Treatment






Additional Treatment Information






Doctors Contact Information For Additional Treatment






Insurance Company Information






In What Capacity Can The Mia Moo Fund Assist You?


Please Tell Us Your Story

Please tell us more about your (Son/Daughter). What kind of cleft/palate was he/she born with, what treatments he/she has received, plans for the future and anything else you'd like to include.



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The Mia Moo Fund is an organization that is dedicated to raising awareness and funds towards the management, treatments and surgical procedures of cleft lip & cleft palate.

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