Follow the steps to complete the application form online.

1. Click ‘Get Form’ button to access and download the application form.
2. Fill in basic information about the child, including their complete name, date of birth, and grade level. Be sure to provide a valid student I.D. if applicable.
3. Provide the child's address, including apartment number if necessary, and correct city and zip code.
4. Include the parent's or guardian's contact details, providing both cell phone and day phone numbers.
5. Fill in details about the household, such as the number of people and total annual income.
6. Select the child's ethnicity from the provided options. This information is important for demographic tracking and funding purposes.
7. Indicate the primary spoken language for the child, ensuring proper communication needs are addressed.
8. Answer the health-related questions regarding the child's eye health and any relevant family medical history. Be accurate as this information affects eligibility.
9. Read and understand the consent statement for eye examinations, then sign and date the form as the legal guardian, ensuring that the child's participation is authorized.
10. If applicable, sign the authorization to use insurance benefits, indicating consent for insurance coverage for the eye examination and eyeglasses.
11. Once all fields are completed, review the information for accuracy. Save the changes and download the form. You can then print it or share it with the necessary school or agency.

Ensure your child receives the vision care they need by completing the application online today.