A 501(c)3 Non-Profit Foundation
If you prefer to fill out your application manually you can get the printable version here
Household is defined as all those who live together or are dependent on each other.
If the applicant is a minor, list parent/guardian’s income information.
List all sources of income (i.e. salary, social security, alimony, child support, pension, stocks, bonds, etc.) for all in
I understand the information I submit to Sound of Life Foundation concerning my annual income,
family size, family recourses, insurance, medical history and all financial information is subject to
verification by Sound of Life Foundation and/or their agents. This verification will be done by phone,
letter, e-mail or credit check.
I understand that if I knowingly omit or submit false information, I will be denied consideration for
assistance at any point during the process.
(If Minor, parent or guardian signature requires.)
If signed by power of attorney (POA), please send a copy of POA. The laws of the state of Utah shall
govern the resulting transaction and any claim or dispute arising out of such transaction.
To be completed and signed by patient’s primary care physician
The patient listed above has been medically examined and may be considered a candidate for hearing aid use.
To be completed and signed by patient
I understand that it is in my best interest and recommended by Sound of Life Foundation and the Food and
Drug Administration to receive a medical examination before acquisition of hearing aids. I choose not to
receive a medical examination before acquiring hearing aids.
The current application processing fee is $175 per hearing aid request. If an application is denied, the processing fee will be returned.