Louisiana Center for the Blind STEP Program

STEP Program - Application

Training will begin June 13, 2010 and conclude August 7, 2010. A break is scheduled for July 8th-16th. If you are interested, please complete, detach and return the application by April 9th 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 associated costs. Please note that the fee is $6,500- which is all-inclusive save for transportation costs to and from the program.

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:
Current Grade Level: (for 2009-2010 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?:

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