Light System Application

Application Process

Registration Requirement: You must register with ID.me, a digital identity wallet, to prove your identity before applying.

Required Information & Materials

1. Identity Verification
- Upload a screenshot of your ID.me account membership

2. Personal Information
- First Name (required)
- Last Name (required)
- Date of Birth (required)
- Phone Number (required)
- Email (required)
- Gender (required)
- Ethnicity (required)
- Race (required)

3. Residence Information
- Address (required)
- City (required)
- State (required)
- Zip Code (required)

4. Application Questions
- Are you filling this out for yourself? (required)
- If no, what is your relationship to applicant? (required)
- How did you hear about the Light Up To Live Foundation? (required)
- Is this your first application? (required)
- How do you think the light system will help you? (required)
- Name of person or organization that referred you (required)
- Has anyone in your household ever applied for a light therapy system? (required)
- Why are you applying for a light system? (required)
- Awards/Honors/Accolades (required)
- Brief comments you'd like to share (excluding personal medical information) (required)

5. Military Service Documentation
- Branch of Service (required)
- Dates of Service - From (MM/DD/YYYY format, required)
- Dates of Service - To (MM/DD/YYYY format, required)
- Type of Discharge (required)
- DD214 (Member-4 Form) or official military ID card for active duty (required, max file size 256 MB)

6. Supporting Documents
- Headshot photograph (required, max file size 256 MB)
- ID.me account screenshot (required, max file size 256 MB)

Submission Process

• Complete the online form with all required fields
• Upload required documentation
• Upon receipt of your completed form, a member of the Light Up To Live team will contact you to complete the submission process
• Proof of service documentation is mandatory