Legally Blind - Visual acuity of 20/200 or less in the better eye with correcting glasses, or the widest diameter of visual field subtending an angular distance no greater than 20 degrees.
Partial Vision - Inability to read standard printed material without special aids or devices other than regular glasses.
Physical Handicap - Inability to read or use standard printed material as a result of physical limitations, paralysis, missing arms or hands, extreme weakness.
Reading Disability - Organic dysfunction of sufficient severity as to prevent reading print.
Other Disability - Please specify.
(If you have other certification documentation you may send a copy to the address below.)
An annual $30 donation is requested for receiver use.
The receiver which we will be sending remains the property of the Radio Reading Service and is loaned to you for as long as you wish. Please notify our office if you move. We will need your new address and telephone number for future correspondence.
Please provide the name, address and telephone number of a family member or friend who will be our backup contact.