KCB Technology Grant Application

I have read the entire document titled “Kentucky Council of the Blind Assistive Technology Grant Program Guidelines” and I understand and agree to all terms and conditions contained therein. All information on this application form is accurate to the best of my knowledge and correct to the best of my ability. I understand that I may be required to provide documentation regarding my eye condition, visual acuity, and visual fields if I am found otherwise eligible to receive an AT Grant. I understand and agree that any failure on my part to wholly comply with the “Kentucky Council of the Blind Assistive Technology Grant Program Guidelines” or the “Kentucky Council of the Blind Assistive Technology Grant Application Form” may void this application or otherwise render me ineligible for a KCB grant. By submitting this application, I agree to receive information from the Kentucky Council of the Blind and its chapters including but not limited to activities, events, programs and other materials in the manner that KCB or its chapters deem appropriate.