Project Vision Aid - iPad Assistance Application Start Application Project Vision Aid iPad Assistance Program Application About The Vision of Children Foundation The Vision of Children Foundation (VOC) is dedicated to curing hereditary blindness and other vision disorders while enhancing the lives of visually impaired individuals and their families. For over 30 years, VOC has been at the forefront of funding groundbreaking research aimed at finding cures for hereditary childhood blindness and genetic vision disorders, providing hope to families facing these life-altering challenges. In addition to advancing medical research, VOC is committed to empowering children to experience the world with greater clarity. Through its Project Vision Aid initiative, the Foundation donates essential tools like handheld video magnifiers and iPads to visually impaired children, helping them overcome obstacles in education and daily life. With the generous support of donors, the Vision of Children Foundation continues to brighten the future for visually impaired students worldwide, enabling them to reach their full potential. Applicant Information Important Information: 1. Application for a Project Vision Aid iPad does NOT guarantee that The Vision of Children Foundation (VOC) will be able to provide a device. The Vision of Children relies on charitable donations to pay for these iPads. 2. Application must be fully completed to be considered. Incomplete applications will not be processed. 3. VOC is not responsible if the device breaks or needs repairs. Section 1: Applicant Information 1. Child's Full Name: * First Name Last Name 2. Date of Birth (MM/DD/YYYY): * MM DD YYYY 3. Parent/Guardian Name: * First Name Last Name 4. Relationship to Child: * 5. Mailing Address: * Address 1 Address 2 City State/Province Zip/Postal Code Country 6. Phone Number * 7. Email Address * Section 2: Vision Condition Information Note: Sharing medical details is optional. However, providing this information can help us assess the suitability of an iPad for your child's needs. 8. Child’s Vision Disorder Diagnosis (optional to share): 9. Physician/Ophthalmologist's Name (optional to share): 10. Please describe how your child’s vision condition impacts their learning or daily activities (optional): Section 3: iPad Request Information 11. Has your child used an iPad or tablet before? * Yes No 12. If yes, how has it helped your child? 13. Please describe how you believe an iPad would benefit your child’s education or daily life: Section 4: Financial Information (Optional) Note: Financial information is not mandatory but can help assess need. 14. Does your child qualify for free or reduced-price lunch at school? Yes No Prefer not to disclose 15. Does your child have access to assistive technology at school? Yes No Prefer not to disclose Section 5: Additional Information 16. Is there anything else you would like us to know about your child’s needs? (Optional) Section 6: Parent/Guardian Consent I, the undersigned, consent to provide the information in this form to The Vision of Children Foundation for the purposes of evaluating my child’s eligibility for the Vision Aid iPad Program. I understand that: * • This application does NOT guarantee that The Vision of Children Foundation will be able to provide an iPad, as distribution depends on charitable donations. • The Vision of Children Foundation is not responsible for repairs or replacements if the device becomes damaged or malfunctions. • The application must be fully completed to be considered. • Any medical or personal details are shared voluntarily and will only be used for evaluating eligibility. • VOC may contact my child’s physician with my explicit consent for any further medical verification if necessary. Yes I agree Name of Parent/Guardian: * By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature. First Name Last Name Date * MM DD YYYY
