2010 Electronic Aid Project Application Form

Full Name:

Full Mailing Address:

Best number you can be reached at :

E-mail:

1) Do you currently use a banknote identifier?
     If yes, what do you use? :

2) If you do not use a banknote identifier, what
     method do you use to identify currency?

3) Do you do your own shopping?

4) What community activities, if any, do you
     participate in?

5) Where are you employed?

6) Do you attend a college?
     Where and are you fulltime?

7) What services or products, if any,
     have you received from EOTP?

8) Essay topic (min. words 150) – What will
     the IBILL banknote Identifier mean to you?

The following supporting documents may be required to complete your application. You will receive an e-mail confirming receipt of your application and be informed of what supporting documents you will need to submit by the deadline 12:00 pm of September 20, 2010.

- Certification of legal blindness from an ophthalmologist dated in the last year
- Proof of residency (copy of State I.D., HandiVan pass, utility bill statement in your name)
- One personal and professional recommendation letter

And

- Proof of employment if applicable
- Copy of your fulltime college schedule if applicable
- Proof of age If applicable

Before submitting this application, review your form and be sure that you have completed every question. Incomplete applications will not be accepted. You may print this page out for your records and use to send in with your supporting documents.

You will be notified by email of your application status not later than October 01, 2010. Thank you for applying!

I, certify that I have read this application in its entirety. I further certify that I understand and agree to the terms and conditions as stated. You must agree to submit the form (check box).