Eye-Link MN Assistive Equipment Grant Application

Eye-Link Minnesota provides assistive equipment/technology grants to Minnesota residents experiencing uncorrectable sight loss. Eye-Link welcomes all applicants. The application can be filled out below and submitted online or you can download the interactive PDF to send via email directly to our Director of Applications Jeff Thompson at [email protected].

The Eye-Link Board of Directors reviews and makes decisions on all grant applications on a date received basis. Approved grants may include either new or refurbished equipment. All applicants will be notified of their application status within two business days following Board review.

* Indicates required field

Full Name *

Address Line 1 *

Address Line 2

City, State, Zip *

Home Phone

Email *

Are you currently a client of any state agency like MN Assistive, MCIL or any low vision related agency? Please answer with Yes or No. *

If yes, please provide the name and phone number of your counselor.

How was your need for the equipment/training you are requesting determined?

What type, model or description of assistive equipment or technology are you requesting from Eye-Link?

Optional: I give Eye-Link representatives permission to contact current or former vision counselors with questions related to this grant. Sign below.

Signature & Date

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