Eye Link Registration Form

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Eye-Link Foundation Grant Application

The Eye-Link Foundation provides grants to blind and visually impaired residents of Minnesota for assistive technology and or associated training. The Eye-Link Board of Directors reviews and makes decisions on grant applications on a quarterly basis. Their decisions are final. Applicants will be notified of their status within two business days following Board review. The Eye-Link Board reserves the right to deny funding for any reason. This process and form may be changed at any time without notice.

Use this link to get a Printable Version of the single page application. Braille and printed paper versions of the application are also available by US Mail and can be requested by calling the Foundation at 763-561-6967.

You must be registered, either as active or inactive, with Minnesota State Services for the Blind (SSB). You must have been turned down by SSB for the adaptive technology or training for which you are applying. A copy of your “Denial” letter from SSB must accompany this application.

Complete the form online, print, sign and return by mail. Mail your application to:
The Eye-Link Foundation
M.E. Appelgate
5253 27th Avenue South
Minneapolis, Minnesota 55417

Full Name

Home Address

City State Postal Code

Home Phone Cell or Work Phone

Email Address (If Available)

Current Student? Yes No - If yes, type of school or training?

Are you currently a client of State Services for the Blind? (SSB) Yes No

If yes, name of Counselor Phone

If no, have you been a client in the past? Yes No
If yes, approximately when was your case closed?

If you are an active client of SSB please answer the following:

How was your need for this equipment/training determined?

What type, model, or description of adaptive technology and/or training are you requesting from Eye-Link?

If you were denied by SSB, what reason were you given for being denied?

NOTE: You must attach a copy of your letter of denial from SSB or Counselor to this application! Your application will NOT be processed if a letter of denial is not attached!
The following is optional but would assist Eye-Link in making a prompt response:

I give Eye-Link representatives permission to contact my SSB Counselor on questions related to the specific equipment I am requesting Eye-Link to purchase for me.

Signature _________________________________________ Date ________________________

Mail your application to:
The Eye-Link Foundation - M.E. Appelgate
5253 27th Avenue South
Minneapolis, Minnesota 55417