Follow the steps to complete your application form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Start by filling in your personal information. Provide your last name, first name, middle name, and specify your gender. Then, enter your complete mailing address, which includes the city, state, zip code, and county. Don’t forget to include your email address, the last four digits of your Social Security number, your date of birth, and your telephone number.
3. Next, move on to the income information section. Report your gross monthly income by entering the amount you earn from wages, Social Security, or benefits. If applicable, also include your spouse's gross monthly income. Indicate your source of income by checking any applicable boxes, such as full or part-time employment, welfare benefits, or veteran’s benefits.
4. Answer the questions regarding Medicaid and veteran status by selecting 'Yes' or 'No' accordingly. This information will help assess your eligibility for assistance.
5. Continue filling out the family information. Indicate your living situation by selecting from the provided options, and list the number and ages of any dependents you may have. Additionally, specify whether you currently wear hearing aids and if you have applied to Lions previously.
6. You will need to certify the accuracy of your information by providing your signature and the date when you sign the application.
7. Lastly, ensure that you return the completed application, along with the Citizenship Attestation Form, to the Nebraska Commission for the Deaf and Hard of Hearing using the provided contact details.
8. You can save, download, print, or share your completed form as needed.

Begin filling out your NE Lions Hearing Aid Bank Application online today to ensure you receive the support you need.