If you clicked no and do not live in Iowa, then you may not be qualified for the program. If you have any questions or concerns about this qualifying question, please contact us at 800-606-5099.
If you clicked no, then you may not be qualified for the program. If the applicant is under five years old, please contact us at 800-606-5099.
If you clicked no, then you may not be qualified for the program. If you have any questions or concerns about this qualifying question, please contact us at 800-606-5099.
Annual Total Family Income
(add $9,000 for each additional person)
You may only choose one of the two ringers - Loud/Flashing Ringer OR Tactile Ringer. Please unselect one of them above.
I, (full name above), am applying for a wireless device with the TAI program and agree to do the following:
If you have not applied to TAI, then you will need a professional signature to verify your hearing loss or your speech difficulty. Please enter your professional's information below, and follow the instructions on the next page on how to get verified.
You must receive a signature by your doctor, audiologist, voc rehab counselor, state or federal agency representative, or any other licensed professional in the field of hearing or speech.
The professional should be YOUR "personal" professional, such as your family doctor, a regular audiologist, a sign langauge interpreter you know. Someone that you have an established relationship with.
Their signature verifies you have a need for specialized telecommunications equipment to assist communication over the telephone.
It is recommended that after you submit this application you reach out to your professional to let them know they will be receiving an email from Telecommunications Access Iowa requiring their verification and signature.
By my signature below, I certify that all of the above information is true. By signing this application form, I agree to participate in any follow up survey in order to assure quality customer service and satisfactory use of my equipment. I understand that I am only allowed to receive one item or package of items per family household every five years. I become the owner of the items I receive and am responsible for the maintenance and warranty. I must use the voucher at an authorized dealer by the deadline listed on the form. I agree to pay any remaining cost that is not covered by the Telecommunications Access Iowa Voucher Program.