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foundation for sight and sound logo

When SIGHT dims to darkness...
When SOUND fades to silence
The Foundation For Sight and Sound can help.

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Foundation for Sight and Sound

PO Box 1245 Smithtown, NY 11787


Hearing Aid Counter
Since January 2009
Our Help America Hear Program
has provided

738

People with hearing aids



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Guide Star

Foundation For Sight and Sound is proud to be at the Silver level at the Guide Star Exchange, the better Business Bureau of not-for profits.

 

Thank you!

The Foundation for Sight & Sound’s Help America Hear Program thanks you for TAKING THE FIRST STEP TOWARDS IMPROVING YOUR QUALITY OF LIFE WITH BETTER HEARING.

Please fill out the information below to receive your hearing aid application.
NOTE: This is NOT the application. The application will be available for download upon completing this form.

 

Title

*First Name

Middle Name

*Last Name

Company

*Address Line 1

Address Line 2

*City

*State

*Zip Code

*E-mail address

*Phone Number

Fax Number

Please take a moment and help us learn about you. Your responses to the following questions are for research only and have no impact on the outcome of of any application submissions.
Who are the Hearing Aids for?
If other please explain:
 
Age of Applicant:
Your Relationship:
If other please explain:
 
Age of Person Filling Out this Form:
Gross Household Income of Applicant:
How Did You Hear About Us?:
If Other Website or Other please explain:
 
Do you have any Comments or Concerns?
Thank You!
Please be assured Foundation For Sight & Sound does not share or sell any information provided to us.

 


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c 2012 Foundation for Sight and Sound
The Foundation For Sight & Sound is a Registered 501C3 Not-for-Profit Charity.

Privacy Policy: The Foundation For Sight & Sound does not collect information from site visitors, only from scholarship applicants. The applicant information collected is used exclusively to select a scholarship recipient. Applicants will only be contacted if there are clarifying questions regarding the application information or to inform applicants of their status.

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