request an application
Jacob's Ride was founded on the premise of raising awareness for Cochlear Implants and those impacted by hearing loss. Through generous grants and donations we can now help secure Cochlear Implant surgeries for qualifying patients. To begin the process or request additional information, please fill out the form below.
Due to demand, we temporarily have a waitlist for our Application Submissions. If you are interested in applying for our Cochlear Implant surgery funding, please fill out the form below to be added to the waitlist, and we will let you know as soon as we are accepting submissions.