Special Services Online Application

Welcome to the online application for Special Services. Please fill in all fields. If you have questions or need help, please contact the office at (314) 832-7172 or by emailing aa@moblind.org

Special Services

Personal Data

VISUAL STATUS

MEMBERSHIP

If not a member of MCB, applicant must submit verification of blindness (letter on official letterhead from doctor, state or private agency.)

HOUSEHOLD INCOME (check all that apply)

Please provide documentation for proof of income

NOTE: If approved, all attempts will be made to make a check payable to the third party. In the unusual event this is not possible, you must provide proof of purchase for the item. SUPPORTING DOCUMENTS A. A signed release of information form must accompany your application B. Utility Bill: If request is for utility payment C. Other Bills: If other than utility, include bill with account number or customer ID D. Purchase: For purchases, include name of business, business address, phone number and price quote on Company letterhead.