Application for Cochlear Corporation

Associated fees for cochear implant assistance must be paid by applicant/patient to The Cochlear Implant Awareness Foundation after patient/applicants doctor approves equipment needs. 

If we are able to make an equipment match and verify the applicant/patient needs with the doctor, the following administrative and processing fees will be need to be paid in full via the applicant/patient via Paypal before the equipment will be shipped/distributed.

  • Application Fee -$50 administrative fee per application
  • Battery/Battery Charger - $50 processing fee per item
  • Cochlear Implant Upgrade Kit - $1000.00 processing fee per item
  • Coli/Cable/Headpiece/Microphone - $60.00 processing fee per item
  • Controller - $300.00 processing per item
  • Ear Hook/Mic Protector/Phone Clip/Smaller Accessories - $10.00 processing fee per item
  • Cochlear Implant Processor - $500.00 processing fee per item
  • BAHA Processor-$500.00 processing fe per item
  • Other items - fees vary per item
  • Shipping and Handling - fees vary depending on box size and shipping destination. Shipping fees are typically $20 or less. 

If you have already been awarded, or have sought cochlear implant equipment from another organization (such as the CNI), and are applying for financial assistance for surgical, hospital, or other CI related fees only, please do not apply. Your application will not be accepted.

CIAF is a 501(c)(3) non-profit organization which relies primarily on donations to help us to provide cochlear implant equipment to qualified applicants without cost to the family or individual in need. As part of our program, we require applicants to complete a personal statement as to how the cochlear implant will improve their life. We also require a photo of each applicant to accompany his/her application. While the personal statement gives a voice to our mission, photographs provide a visual connection for our supporters and helps bring an applicant’s story to life. Both components greatly assist us in promoting our mission to help more people hear! If the applicant is between 13 and 18 years of age, both the applicant and a guardian should write separate statements. If the applicant is less then 13 years of age, a statement from a guardian is sufficient.

I authorize the Cochlear Implant Awareness Foundation, hereafter referred to as “CIAF” to publish photographs of me, and my name and likeness, for the use in CIAF print and online marketing materials as well as other CIAF publications. I hereby release and hold harmless CIAF from any reasonable expectation of privacy or confidentiality associated with images specified above. I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type associated with the taking or publication of these photographs or participation in company marketing materials or other CIAF publications. I acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever. I hereby release CIAF, its contractors, its employees, and any third parties involved in the creation or publication of marketing materials, from liability for any claims by me or any third party in connection with my participation.