Baby Alert System - State of New Jersey - state nj 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your last name in the designated field, followed by your first name. Ensure that both names are printed clearly.
3. Fill in your street address, making sure not to use a PO Box. Next, enter your city, state, and zip code accurately.
4. Provide your home phone number and either an email address or fax number for communication purposes.
5. Input your baby's name and date of birth in the specified format (Mo/Day/Year).
6. Attach an audiogram or have a licensed audiologist or physician sign the application to verify hearing loss.
7. Sign the application to attest that all information is accurate and that you meet eligibility requirements.
8. Submit the completed form to the DDHH Equipment Distribution Program via mail or fax as indicated.

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