JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Junior Fellow Application - Project InSight
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Grade in School
*
Your answer
Cell Phone Number
Your answer
School or Organization Name
*
Your answer
Adult Advisor's Name
*
Your answer
Adult Advisor's Email Address
*
Your answer
Explain your current interest in any of the fields related to eye health, vision care, or working with people with visual impairments.
*
Your answer
Explain why you are interested in being a Project InSight Junior Fellow.
*
Your answer
What is your personal relationship with vision?
*
Your answer
What are some areas you would like to explore in the fields related to eye health, vision care, or working with people with visual impairments?(Select all that apply)
*
Optometry/Ophthalmology
Lenscrafting
Educational support for people with visual impairments
Orientation and Mobility (for example, how people use white canes)
Apps for people with visual impairments
Architecture that accommodates people with visual impairments
Guide Dogs
Public Health as it relates to eye care
Public Policy to support people with visual impairments
Other:
Required
Do you have any questions or want to share something that we didn't ask?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of The Big Picture Company.
Report Abuse
Forms
