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Eye-Link Minnesota Assistive Equipment Grant Application

Eye-Link Minnesota provides assistive equipment/technology grants to Minnesota residents experiencing uncorrectable loss of their sight. Eye-Link welcomes all applicants. The application can be filled out and submitted online at mn.eye-link.org, or you can email a copy directly to our Director 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 *

First

Last

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone *

Cell or Work Phone *

Email address (if available) *

Are you currently a client of of any state agency like MN Assistive, MCIL or any low vision related agency? *

Yes No

If yes, please provide the name of your counselor? *

Counselor's Phone Number *

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

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

The following is optional but would assist Eye-Link in making a prompt response to you:

I give Eye-Link Minnesota representatives permission to contact any current or former vision counselors on questions related to the specific equipment that I am requesting to have Eye-Link purchase for me.

Signature *

Date *

Applications can be submitted either online or emailed directly to: [email protected]
For more information visit mn.eye-link.org or call Jeff Thompson at 612-554-2530 if you have questions or need assistance.

I agree to receiving marketing and promotional materials

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Eye-Link Minnesota Assistive Equipment Grant Application

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Board of Directors