Welcome to The Lighthouse Pediatric Hearing Aid Application
PLEASE READ CAREFULLY
ALL applicants are required to provide an email address. You may use a social worker or other organizational representative’s email address with their permission, but you are responsible for following up with them on any emails received regarding your application.
IMPORTANT: Please be prepared to upload:
– Completed clearance, audiologist recommendation, and insurance affidavit (COMPLETE AND PRINT PRIOR TO APPLYING)
– Proof of income (ex: check stubs, Disability award letter, etc.)
– Proof of identification (ex: valid driver’s license, consulate ID card, etc.)
– Proof of Georgia residency (ex: utility bill, lease agreement, etc.)
– Copy of your insurance statement of coverage, ONLY IF you have insurance that covers hearing aids AND is a high-deductible plan
— Copy of current (<3 months old) hearing test
You CAN use your phone to take a photo of these items! Please ensure that ALL files are clearly legible and that the entire document can be seen.
If you are prepared to complete the Lighthouse pediatric hearing application at this time, please check the box below to continue.