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City of Lincoln
Fire & Rescue Department

For the Deaf and Hard of Hearing

 

*** Only available to residents of Lincoln, Nebraska. Ages 5 to Adult ***
 
*Contact Name:
 
*Installation Address:
 
*Phone Number (Including Area Code):
 
Email Address
 
*Name of Person this is for:
 
*Age of Person this is for:
 
*How Many Floors / Levels Does the Individuals House / Apartment Have?
 
*How Many People Live in the Household?
 
*How Many People Living in the Household are Deaf or Hard of Hearing?
 
*The Family Members that Could Benefit from this Program, Do They Consider Themselves Deaf or Hard of Hearing?
Deaf
Hard of Hearing
 
*How many separate sleeping areas or bedrooms in the home are utilized by individuals that could benefit from this device?
 
*During your waking hours, do you wear amplification or a Cochlear ImplantI?
Yes
No
 
 
*If you do wear amplification or a Cochlear Implant, is it adequate to alert you to the sound of a normal smoke alarm?
 
*If you have any other additional comments please provide them below and indicate the days of the week and times, if any, that would work best for you to schedule an installation appointment.
 
*If an interpreter is available, would you like one to be present at the installation? (An interpreter may not be available.)
Yes
No
 
Do you have friends or family that live in Lincoln that you think would benefit from this program? If so, please provide their information below.
* fields required to submit this form

If you do not have internet service you can:

Mail to:
Lincoln Fire & Rescue
ATTN: Deaf & Hard of Hearing Smoke Alarm Request
1801 "Q" Street
Lincoln, NE 68508

Or Fax to us at: (402) 441-8292


Fire & Rescue Department