Hearing Dogs Program

Hearing Dog Application


Dear applicant,

Thank you for your interest in a Hearing Dog from The Sam Simon Foundation. Please download, fill out and mail the application along with a current audiogram (hearing test). If you have a total hearing loss, and do not benefit from the assistance of Hearing Aid(s) or Cochlear Implant (s), you may simply include the date you were last tested and note that you have a 100% total hearing loss.

The audiogram submitted with your application for a Hearing Dog must include a hearing test conducted both with and without any currently used hearing aid devices.

The Sam Simon Foundation does not request any fees for consideration of a Hearing Dog. Once we have had an opportunity to evaluate your application, we will notify you by mail or email to let you know if you qualify to go forward with a scheduled in-home interview.

If you have any questions about your application or the audiogram, please notify us by email, fax or phone. Please send your completed application and copy of your current audiogram to The Sam Simon Foundation, 30765 Pacific Coast Hwy #113, Malibu, CA, 90265.

We look forward to receiving your application and thank you for your request.

Hearing Dog Application

To apply for a Hearing Dog, you will need to fill out an application and send it back to us along with an audiogram from an audiologist.

After your application has been reviewed, you will be notified as to whether or not you qualify for the next step. That next step will be an in-home interview by one of our Instructors.


Continue to Application Form