Early Childhood Application

The early childhood initiatives of the National Federation of the Blind provide young blind children and their families with support and guidance to master the fundamental skills of literacy and independent travel. Please complete this form to sign up for one or more of our early childhood programs.

Note: All fields with an asterisk (*) are required.

Parent/Guardian Information

First Name *

Last Name *

Street Address *

Street Address Line 2 - Opcional

City *

State/Province *

Postal Code *

Email *

Primary Phone Number *

Primary Phone Type *

Secondary Phone Number - Opcional

Secondary Phone Type - Opcional

Please select your relationship to the child. *

Please describe your relationship to the child. - Opcional

Participating Child's Information

First Name *

Last Name *

Birth Date:*

Gender *

Other Information

Please select the format(s) that you prefer information and program materials. *

Braille

Print

Electronic/Digital

How did you hear about this program? *

Please describe how you heard about this program. - Opcional

Please identify any additional disabilities impacting this child’s learning: - Opcional

The National Federation of the Blind pursues grant funding to support our programs, and some of these grantors ask us to describe the backgrounds of participants in our programs. In order to improve our program delivery and to respond to these requests, we ask you to answer the following questions:

Ethnicity *

East Asian or Asian Indian

Black, African American, or African

Hispanic, Latino, or Spanish

Native American or Alaska Native

Native Hawaiian or Other Pacific Islander

Other

Prefer Not to Say

White

What is the approximate average annual household income for this child’s primary residence? *

Please select the “Submit” button to complete your NFB Early Childhood Initiative application. Please allow up to four weeks to receive your materials.