Smaller Text Bigger Text Email Us Print
Text Only
Tiếng Việt
Tell a Friend

Download application
Click your language

Apply Now in English

Apply Now in Spanish

Apply Now in Chinese

Apply Now in Vietnamese

Apply Now in Hmong

Apply Now in Russian

To download an application, please click on one of the buttons above. If this does not work, please download Acrobat Reader 8.0 which includes a PDF Read Out Loud tool.


Or call us today

 Điện thoại

An Official State of California Program
With an amplified phone, you'll never miss a single word.

Apply now for your California Phone.

It’s easy to apply for your free specialized phone equipment.
Just follow these simple steps:

  1. To download an application, click your language choice on the right.

  2. Print out the application, fill out the first section, and sign it.

  3. Certification: Section 2 of the application needs to be signed by any medical doctor, physician assistant, audiologist, opthalmologist or other eligible agent, specified on the form. If you don’t have one of these available, we can help you find a professional Certifying Agent to sign your form.

    Click Here to Find a Certifying Agent

  4. Once your form has been completed and signed by a Certifying Agent, either take it to a Service Center near you to get your new phone equipment, or mail or fax your form to our Contact Center.

If you decide to mail or fax your form to the Contact Center, you will receive your approval by mail, within about one week. You then need to call the Contact Center at 1-800-806-1191 to discuss what is the best phone for you.

About Us | Program Website | Contact Us | Privacy Policy