This program is to assist underserved hard of hearing individuals, who have exhausted all other options for assistance with hearing aids, and fit the income eligibility guidelines. If you fit within the eligibility requirements and have carefully reviewed the criteria for income, assets and hearing loss, you may be eligible for services from the Miracle-Ear Foundation.  Please click here to review the eligibility requirements. Please note that the standard $150 application fee has been waived for this mission activity.

Complete the application in full and verify that the information you are submitting is correct regarding household size and household income. Proof of income is required for every adult in the household and you will be asked to provide specific documents based on the details provided in the Household and Financial Information section.

When you click Apply below, you will be asked to create an account with our partner, Submittable, before starting the application process.  

The application is separated into five sections outlined below. You may save as a draft at any time and return to it later. If you need help completing the application at any time, click the Invite Collaborators link at the top of the page to invite a companion to assist you, or contact DeeAnne at 763-268-4278 for assistance.
Section 1: General Information – Applicant/Parent/Guardian completes
Section 2: Household & Financial Information  – Applicant/Parent/Guardian completes
Section 3: Medical Clearance – Applicant/Parent/Guardian completes
Section 4: Biography and Testimonial Consent form - Optional, Applicant/Parent/Guardian completes
Section 5: Program Agreement Form -- Applicant/Parent/Guardian signature required

Children (18 and younger)
Child applicants must upload an audiogram completed by an audiologist and a medical clearance form completed by a physician (MD, ENT) to be fitted with hearing aids. The medical clearance form can be downloaded in section 4 of the application.

If you have questions or need assistance completing the application, please contact the Miracle-Ear Foundation at (763) 268-4278.

We use Submittable to accept and review our submissions.