NFB-NEWSLINE TEXAS APPLICATION
Please answer all questions. If you have difficulty completing this form, contact our office for assistance. Liz Wisecarver is our program coordinator, and you can reach her at 281-968-7634. Or, Kayleigh Joiner, who serves as the program assistant can be reached at 281-968-7684.
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First Name *
Last Name *
Street Address *
Street Address 2
Please, answer this question if you live in an apartment, or have a suite or unit number as part of your address.
City *
State *
Zip *
Telephone Number *
Email Address
Providing us with your email address allows you to forward news stories that you want to save to yourself. This option will not be available if you opt not to share your email address. Having your email address also allows us to communicate with you about changes and updates to the service. So, we hope you will share your email address with us.
Preferred Language
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Date of Birth *
Please, write your date of birth as mm/dd/yyyy.
Are you legally blind? *
If you are not legally blind, list other print disabilities you have.
Do you currently receive services from any of the following? *
Check all that apply to you.
Required
I am *
Check all that apply.
Required
If you are a student, where do you go to school?
We are collecting this information in order to let you know about scholarship opportunities our organization provides.
If you are employed, where do you work?
If you were referred to the program by a chapter of the NFB of Texas, which chapter referred you?
If you were referred by an individual, who referred you?
Are you currently a subscriber to NFB-NEWSLINE? *
Newsline is our free audio newspaper and information service.
May we use the contact information you have provided to keep you updated about NFB-NEWSLINE and other programs and services offered by the National Federation of the Blind of Texas? *
Our organization hosts free opportunities to learn more about how to use Newslne, and we also offer other programs of interest to blind Texans of all ages. We encourage our subscribers to attend any events they find interesting, and we use contact information to let them know about the availability of programs and services. We do not share your contact information with anyone outside the NFB of Texas. So, it is safe.
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