APPLICATION FOR HEARING AIDS
APPLICATION FOR HEARING AIDS (Spanish)
If you are interested in participating in our program, please download and bring this form with you to your child’s hearing care appointment.
Hear in the Fox Cities will provide sliding-scale services to those with financial need. If you have questions about our program and/or whether or not your child qualifies, please contact us at email@example.com
Hear in the Fox Cities does not discriminate on the basis of the following characteristics including, but not limited to race, color, ethnicity, national origin, citizenship status, religion, sex, age, affectional/sexual orientation, gender identity or expression, veteran status, personal appearance, genetic information, political affiliation, familial status, marital status, or disability in any of its policies, procedures or practices. This non-discrimination policy covers membership to our board of directors, committees, volunteers, vendors and our clients.