Louisiana Center for the Blind STEP Program

STEP Program - Application

Training will begin June 8, 2008 and conclude August 9, 2008. A break is scheduled for July 6th-13th. If you are interested, please complete, detach and return the application by April 18 or call Eric Guillory at 800-234-4166.

Due to limited space, we cannot guarantee that every applicant will be granted enrollment. Applicants must have an open case with their state’s vocational rehabilitation agency or other entity for funding to cover tuition costs. Priority is given to Louisiana residents.

Student's Name:
Parent's Names:
Mailing Address:
City:
State:
ZIP Code:
Email Address:
Telephone Number:
Student's Age:
School:
Grade Level: (for 2008-2009 school year)
Visual Acuity:
Cause of Blindness:
V.I. Teacher:
Rehab Counselor
Do you use a cane?:	Yes No
Do you use Braille?:	Yes No
Do you use large print or magnification devices?:	Yes No
Hobbies:
Do you have any other disabilities or medical conditions?:

Programs & Services

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