Sight-Hearing Assistance Application

The Bartlett Lions Club and Foundation has a mission is to help people receive free eye care and glasses, eye surgery and hearing aids. We help people based on income level and need. We have an application process, and it is very important that the application be filled out completely and accurately. You have the option to fill out the application below, online, or download a paper copy of the application, fill it out and email, text or mail your application and supporting documents to the information at the top of the application.

Below is the information you must submit to complete the application. The supporting documentation is proof of the information provided on the application, and can be sent to the email you receive after you submit the online application.

● Copy of the applicant’s state issued photo ID.

● Copy of proof of residency containing the name of applicant (mortgage statement, utility bill, food stamp statement, SSI statement, WIC statement, etc.)

● Copy of monthly income proof (check stub(s), SSI statement, 1040 form, retirement, child support, etc.)

● If needing eye surgery, we need a diagnosis letter from your optometrist. If you don’t have one, we will need to send you to an optometrist before referring you to a surgeon.

If you cannot provide any of the requested information or have no income, we must have a letter stating the reasons why. Once we receive your application and documentation, the Services Committee will review it and be in touch.

For any questions about the application process, please see Assistance Application FAQs below.  This information is also available in Spanish.