Lions Hearing Aid Bank - Nebraska Commission for the 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information. Fill in your last name, first name, middle name, gender, mailing address, city, state, zip code, county, email address, last four digits of your Social Security number, date of birth, and telephone number.
3. Next, provide your income information. Indicate your gross monthly income and that of your spouse if applicable. Check the appropriate sources of income such as employment or benefits.
4. Answer the questions regarding Medicaid and veteran status by selecting 'Yes' or 'No'.
5. In the family information section, indicate your living situation and number of dependents. Specify if you currently wear hearing aids and if you have applied to Lions before.
6. Finally, certify that the information provided is accurate by signing and dating the application.

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