Applications

If you would like to apply for assistance, please click on the Child or Adult application links below.
NEW:   Now you can fill out the applications online!  Then print them and mail to
Sertoma Speech & Hearing Fndtn. 4443 Rowan Rd., New Port Richey, FL 34653

 

A copy of the application with original signatures and supporting documents must be mailed to:
 
Sertoma Speech & Hearing Foundation
4443 Rowan Rd.
New Port Richey, FL 34653
 

BEFORE YOU MAIL, DON'T FORGET TO:

  • Fill out application completely and correctly (all pages)

  • Sign and date all pages where indicated

  • Have a witness sign and date where indicated (anyone over 21)

  • Include proof of income from ALL sources

  • Include a copy of any and all insurance coverage

NOTE:  Incomplete applications will cause a delay in processing your request
 
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