SOLF Qualification Form Dear Applicant, Thank you for contacting the Sound of Life Foundation Program for hearing aid assistance. Our goal is to provide hearing aids to individuals who meet the criteria and are approved for assistance. This program is designed to assist those who have no other resource available to them. We are a program of last resort. The questions below will help you quickly determine if you meet qualifications for the SOLF program. If you do meet our initial qualifications, you will be able to continue on to complete an application. (There is a non-refundable $50 application fee, and then if you are selected for the program, there is a $350 program fee.)Are you applying yourself, or on behalf of another person?*Applying yourselfApplying on behalf of someone elseApplicant's Contact InformationApplicant's Name* First Last Applicant's Email* Applicant's Phone*Person, if other than applicant, completing this form.Your Name First Last Your Email Your PhoneRelationship to ApplicantApplicant Personal InformationYou're doing great; keep going. In this step, you will learn about the financial qualifications for the program.Are you 18 or older?*YesNoHave you had a full hearing evaluation in the last 6 months?*YesNoAre you financially restricted from purchasing hearing aids?*YesNoHow many people live in your household?*12345SOLF is currently only offered in the United States. Please select the state of your current residence.State* AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Income Requirements Household Size Gross Monthly Income Annual Income 1 $2,010 $24,120 2 $2,706 $32,480 3 $3,403 $40,840 4 $4,100 $49,200 5 $4,796 $57,560 Based on the US Table shown, do you qualify financially?*YesNoLast Two QuestionsIf you qualify for the SOLF Program, do you intend to complete an application?*YesNoMaybeWere you able to answer “Yes” to all of the questions on the form so far?*YES, Let's Go!NO, Unfortunately Not This iframe contains the logic required to handle Ajax powered Gravity Forms.