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Disability Services for the Blind

Complete this form to see if you are eligible for assistance Division of Services for the Blind.

1 of 9 Screener Questions

What is your date of birth (mm/dd/yyyy)

Example: January 5, 1998 would be 01/05/1998.

Are you a veteran/retiree, active duty service member, member of the National Guard or Reserves, or their spouse?

Are you an American Indian, Alaskan Native, Native Hawaiian, or Other Pacific Islander?

Do you have a disability that impacts any of your major life activities? (Work, School, Activities of Daily Living, etc.)

Do you have a job?

Are you currently enrolled in school?

Do you need help with your English, reading, writing, math, or other academic skills?

Examples include: you have a problem counting change when you buy something, can't pass a drivers test in English, problems reading instructions in English, problems following spoken instructions in English, English Language Learner, etc.

Are you or your family low-income?

Examples include: Income below the poverty line or, receiving Medicaid/ARKids, SNAP/Food Stamps/EBT, TANF, HUD, SSI, SSDI, Free/Reduced Lunch, or are Homeless/Runaway, etc.

Do you or your family move around for farm work or seasonal work?

Are you currently or have you in the past been involved with the criminal justice system? (Arrested, convicted, in prison or jail, on parole or probation, etc.)

Involvement with the criminal justice system does not prevent you from possibly being eligible for services, it is asked to identify the various barriers you may be facing. Additionally, there may be programs that can assist justice involved people.

Do you need help getting into or completing an education or training program, or getting or keeping a job?

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