Full Application
Complete Your Application
You've been invited to submit the full Foundation application. Download the form below, complete it, and return it to us by mail or email. Our team will follow up within a few business days.
Haven't completed the free eligibility screening yet?
The first step is a short, no-cost screening form. Our team reviews it and contacts you with the right next step — before any fee is requested.
Eligibility
Who Can Apply?
We serve adults and children across our community who meet the following criteria. You do not need insurance to apply. Hearing aids are provided to approved applicants without the normal retail cost ($2,000–$7,000+). A processing fee of $150 (one hearing aid) or $300 (two hearing aids) is required — this fee is refundable if your application is denied or if you cancel before receiving your hearing aids. Full sponsorship (no fee) is available for applicants with exceptional financial hardship.
Hearing Loss
Applicants should have a confirmed or suspected hearing loss that affects daily communication and quality of life. A recent hearing test is helpful but not required to begin — we can arrange or request appropriate testing during the review process.
Financial Hardship
Applicants must demonstrate financial need and an inability to afford hearing aids or hearing healthcare through other means.
Adults & Children Welcome
We serve patients of all ages — from young children to seniors. A parent or authorized representative may complete the application for a minor.
Any Insurance Status
You do not need insurance to apply. We welcome uninsured, underinsured, and those whose insurance does not cover hearing aids.
The Process
How the Application Process Works
The process begins with a free eligibility screening — no charge, no commitment. After review, we'll contact you with the most appropriate next step. If invited to apply, a processing fee of $150 (one hearing aid) or $300 (two) is required at that stage. This is not the cost of the hearing aids — it is a processing fee, and it is refundable if your application is denied. Applicants approved for full sponsorship are not required to submit payment.
Step 01
Free Eligibility Screening
Complete the free online screening form. Tell us about the applicant's hearing needs, financial situation, and insurance coverage. There is no charge to submit.
Step 02
Foundation Review
Our team reviews the screening and contacts you — typically within a few business days — with the most appropriate next step: benefit navigation, full application, sponsorship consideration, or a referral.
Step 03
Full Application
Applicants invited to proceed complete the full Foundation application and submit the processing fee. Applicants being considered for full sponsorship are not required to submit payment.
Step 04
Hearing Evaluation
Qualified applicants are scheduled for a hearing evaluation with one of our volunteer audiologists to assess the type and degree of hearing loss.
Step 05
Hearing Aid Fitting & Follow-up
Approved applicants receive hearing aids fitted and programmed by licensed audiologists — provided without the normal retail cost. We follow up to ensure devices are working well.
Apply Now
Download & Submit the Application
Download the application form below, complete it, and return it to us by mail or email along with your application processing fee. Our team will review your application and follow up within a few business days.
- 01Download and print the application form.
- 02Complete all sections clearly and legibly.
- 03Include your application processing fee ($150 for one hearing aid, $300 for two). This is not the cost of the aids — it is a processing fee. It is refundable if your application is denied. Applicants approved for full sponsorship are not required to submit payment.
- 04Mail or email the completed form to us — contact details are on the form.
- 05Our team will follow up within a few business days.
Application Form
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Download Application (PDF)