Application

Eye-Link Minnesota provides adaptive technology and assistive equipment grants to
residents of Minnesota who are experiencing uncorrectable sight loss or who are legally
Blind. The Eye-Link Minnesota Board of Directors reviews and makes decisions on grant
applications on an as-received basis. Their decisions are final. Applicants will be notified of
their grant status within two business days following the Board review. Grants may include
either new or refurbished adaptive equipment. The Eye-Link Minnesota Board reserves the
right to deny funding of a grant for any reason.

You may PRINT a copy of this grant application or fill it out on-line at mn.eye-link.org. You
may request a copy in Braille or large print by calling Eye-Link Minnesota at 763-561-6967.
Being registered with Minnesota State Services for the Blind (SSB) as active or inactive is
recommended. Eye-Link Minnesota works closely with SSB counselors to determine need
and available services. If your request has been denied by SSB or an equivalent organization,
a letter of denial should accompany your Eye-Link Minnesota grant application.
Please fill out the form below and send your completed application to:

Eye-Link Minnesota
Jeff Thompson
6835 East River Road, Fridley, MN 55432
Or email to: Jeff Thompson

Active and inactive clients of SSB please answer the following questions:

How was your need for this equipment/training determined? *

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

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

Have you ever been a member of the Armed Forces or Reserves? *

Yes No

If yes, what branch? *

If applicable, please attach a copy of your letter of denial from SSB or an equivalent to this application. NOTE: Your application will not be processed if a letter of denial is not attached or until received! Please mail to the following address:

Eye-Link Minnesota
C/O Jeff Thompson
6835 East River Road
Fridley, MN 55432

el-mn-application-09-10-21-form.pdf
File Size:	149 kb
File Type:	pdf

Eye-Link Minnesota Assistive Equipment Grant Application

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