[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-304739-105":53,"doc-detail-304739-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","cccdp-grant-application-family-portion","CCCDP Grant Application - Family Portion","","Carolina Children’s Communicative Disorders Program (CCCDP) grant application instructions and the Family Portion form for families seeking financial assistance for hearing aids for children with hearing loss in North Carolina. The document explains eligibility under age 21, residency, and income-related criteria, and lists required supporting materials including insurance denial letters, current hearing test results, a recent photo, and recent federal and NC tax forms. It also outlines sections for child demographics, insurance coverage, communication mode, hearing-loss details, household information, employment, income, housing, expenses, and medical insurance details, with authorization and signature requirements.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/cccdp-grant-application-family-portion/304739/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/cccdp-grant-application-family-portion/304739.png","ImageObject",442,249,{"name":88,"@type":89},"Jasmine","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-28","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":79},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"Who must complete the CCCDP grant Family Portion and sign the application?","Question",{"text":108,"@type":109},"The Family Portion must be filled out completely, and the form must be signed by an adult parent or guardian. The assistance of the child’s fitting audiologist is needed to complete the form.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What documents are required to avoid an incomplete application?",{"text":113,"@type":109},"Include a copy of the child’s insurance card(s), a denial letter if turned down for Medicaid/NC Health Choice, the most current hearing test, a current photo, recent signed IRS 1040 and NC D-400 tax forms (or contact the program if not filed), and the financial eligibility statement with the family and audiology portions.",{"name":115,"@type":106,"acceptedAnswer":116},"What information is requested in the Family Portion form?",{"text":117,"@type":109},"The form requests child demographics, insurance coverage and hearing-loss details, communication mode, school/class placement details, household and sibling information, employment and income for parents, housing and real estate information, annual expenses, and medical insurance premium and deductible details.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},304739,1790499887,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":79,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":135,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":73},2336478487870,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Dear Family,  \nThank you for your interest in the Carolina Children’s Communicative Disorders Program (CCCDP) . The CCCDP financial assistance program provides funding for hearing aids for children with hearing loss whose families do not qualify for other public programs, and who do not have adequate income to obtain devices. Since 1993, the North Carolina General Assembly has provided this grant to assist families in the state who have children with hearing loss. North Carolina is the only state in the US to offer funding such as this for children with hearing loss. Remember to thank your legislators so that programs such as this can continue.  \nChildren enrolled in the grant program must be North Carolina residents under 21 years of age. Acceptance is based on income, family size, other medical expenses, and the limitations of insurance and other resources. The financial criteria are somewhat flexible so that as many children as possible are served. Please fill out the following application completely. You will need the assistance of your child’s fitting audiologist to complete the form. Please note that while the program pays for hearing aids, it does not pay for loss or damage of the devices, or any fitting fees that your audiologist will charge.  \nRemember to include the following as incomplete applications will not be considered:  \n• A copy your child’s insurance card(s) .  \n• A letter of denial if you have been turned down for Medicaid or other insurance.  \n• The most current hearing test.  \n• A current photo of your child.  \n• Your most recent, signed, federal tax form 1040 (If you did not file taxes, please contact us) .  \n• Your most recent, signed, NC state tax form D-400 (If you did not file taxes, please contact us) .  \n• The financial eligibility statement, the family portion and the audiology portion of the application.  \nYou can mail or fax your completed application and documents to the address shown on this letter. Upon acceptance into the program, you will be contacted to set up an appointment to see a UNC audiologist and a physician for medical clearance. This visit will only happen once and all of your follow up care will be provided by your local caregivers. Costs for the UNC visits will be covered by the grant program.  \nPlease contact us if you have any questions and thank you again for your interest! Sincerely,  \nErika B. Gagnon, AUD Program Director, CCCDP  \nCCCDP GRANT APPLICATION  \nFamily Portion  \nMust be filled out completely  \nDate:    \nName of Child:   Name of Parents/Guardian:   Street Address:   City:   State:   Zip:   County:    \nPhone Number:   Email Address:  \n_______________________________________  \nDate of Birth:   Place of Birth:   Gender: Male Female UNC Medical Record Number:    \n\n| Is the child covered by private health insurance?   Yes | No |\n| --- | --- |\n| Is the child covered by secondary health insurance?   Yes | No |\n| Is the child covered by Medicaid or NC Health Choice?   Yes | No |\n| Has the child applied for Medicaid or NC Health Choice and been turned down?   Yes | No |\n| Congenital hearing loss (born with) or Acquired hearing loss |  |\n| Age at diagnosis:   Age at onset of hearing loss:\u003Cbr>Etiology (cause) if known:   |  |\n|  | ____________ |\n| Mode of communication: Spoken Language Sign Language Total Communication School: | Cued Speech |\n|  |  |\n| Type: Home Residential Self-contained Mainstream ( fully or\u003Cbr>Date of First Hearing Aid Fitting: | partially) |\n|  |  |\n| Consistency of hearing aid use: all waking hours some waking hours | never |\n\nWhere did you hear about the CCCDP grant program?   I authorize CCCDP and UNC-Chapel Hill to use pictures, statements or other documentary evidence of  \nmy child’s participation in the CCCDP grant program.  \nI authorize CCCDP and UNC-Chapel Hill to release results of the audiologic and otologic evaluations to the dispensing audiologist.  \nParent/Guardian signature:    \nFor your child to be considered for enrollment in the CCCDP G","cbCaio4Qn5FRHFwu","https://ap.wps.com/l/cbCaio4Qn5FRHFwu","pdf",379109,6,"English","# CCCDP Grant Application - Family Portion\n## Eligibility and program notes\n## Required documents for incomplete applications\n## Program process after submission\n## Family Portion form sections\n## Authorization and signature","[{\"question\":\"Who must complete the CCCDP grant Family Portion and sign the application?\",\"answer\":\"The Family Portion must be filled out completely, and the form must be signed by an adult parent or guardian. The assistance of the child’s fitting audiologist is needed to complete the form.\"},{\"question\":\"What documents are required to avoid an incomplete application?\",\"answer\":\"Include a copy of the child’s insurance card(s), a denial letter if turned down for Medicaid/NC Health Choice, the most current hearing test, a current photo, recent signed IRS 1040 and NC D-400 tax forms (or contact the program if not filed), and the financial eligibility statement with the family and audiology portions.\"},{\"question\":\"What information is requested in the Family Portion form?\",\"answer\":\"The form requests child demographics, insurance coverage and hearing-loss details, communication mode, school/class placement details, household and sibling information, employment and income for parents, housing and real estate information, annual expenses, and medical insurance premium and deductible details.\"}]","CCCDP Grant Application - Family Portion | PDF",1789816629]