EASY AS 1, 2, 3 ...

Please help us identify students from your program to receive a Sight for Students award. Children who failed their state-mandated vision screening but who, for financial reasons, were unable to secure proper follow-up diagnosis and prescription glasses, if needed, are prime candidates.

1. The eligibility criteria are:
   
   
   • Family income is no more than 200% of federal poverty level
     
     
   • Child is not eligible for Medicaid or other vision insurance
     
     
   • Child is 18 years old or younger and has not graduated from high school
     
     
   • Child is U.S. citizen or resident alien
     
2. Complete the Sight for Students application and return it to:
   
   Vision Service Plan
   Attention Mary Kearney/ Finance
   P.O. Box 997100
   Sacramento, Ca 95899-9989
   Fax: (916) 858-5388
   Awards for services are made on a first come, first served basis so please respond as soon as possible.
   
   
3. The students you select will receive a Sight for Students award. The award provides an eye examination and prescription lenses and a covered frame at no cost, if prescribed.
   Yes, we are interested in participating in Sight for Students and will abide by the eligibility criteria for the program in selecting students to be provided free eyecare services.
   _______________________________________________________________________
   Date
   _______________________________________________________________________
   Contact Name
   _______________________________________________________________________
   Name of Organization
   _______________________________________________________________________
   Organization's Address
   _______________________________________________________________________
   City State Zip
   _______________________________________________________________________
   Signature of Contact
   (_____)_________________________________________________________________
   Telephone
   (_____)_________________________________________________________________
   Fax Number
   _______________________________________________________________________
   
   Number of Benefit Forms Requested for Needy Students
   (Not to exceed 10% of the children enrolled in your program)
   Thank you for participating in Sight for Students!
   Please take a moment to ensure the information is correct and complete. If you have questions about the Sight for Students program, please contact
   Mary Kearney at Vision Service Plan, 1-800-852-7600, Ext. 5156

See also:
     Partnership between Head Start and Vision Service Plan