The SEE THE FUTURE “Tools for Life” Program
P.O. Box 63022
Colorado Springs , CO 80962-3022
You may fax applications or questions to: 719-471-3210

  Application Deadline: April 15, 2009

_______________________________________________________________

The SEE THE FUTURE Fund is pleased to award scholarships to qualified visually impaired and blind students who are Colorado residents. This scholarship fund is made possible through generous donations by ophthalmologists, optometrists, opticians, staff, corporations, educators, foundations and many others with an interest in the lives of the visually impaired and blind. All scholarships are awarded based on individual need.

AMOUNT:

Scholarships will be awarded in the form of adaptive technology which is medically necessary due to a student’s visual impairment or blindness.  Technology will be purchased by the SEE THE FUTURE Fund and delivered to the recipient.  Requests can be made for adaptive technology for no less than $500 and no more than $5,000.

Who is Eligible?

Any Colorado resident * who submits a completed application prior to the April 15, 2009 deadline, and meets the following criteria:

^* For STF purposes, a Colorado resident is one who has lived in Colorado as a dependant at least one year prior to April 15, 2009 (April 15, 2008 – April 15, 2009); or has held a valid Colorado ID for at least one full year prior to April 15, 2009.

1.      Educational Criteria: 

Student must be at least entering a Pre-K program of school and must NOT be holding a high school diploma (Pre-K – Transition).  Student must also be working with a certified teacher of the visually impaired (TVI).

2.      Vision Loss Criteria:

20/70 or less, central vision, best corrected, in better eye,
and/or
20 degree peripheral field or less in better eye
or
20/40 or less, best corrected, in better eye, and associated field loss with a prognosis of further vision loss secondary to underlying disease process.

Entitlement vs. Need:

“Tools for Life” is a “Need Based” program and not an “Entitlement Based” program.  Being visually impaired or blind does not entitle the student to receive assistance in purchasing tools.  Qualifying financial brackets (see below) determine the amount which the SEE THE FUTURE Fund will assist in the purchase of technology.  All families will be required to pay at least a portion of the purchase price.

Financial Brackets (Please note that “total family Adjusted Gross Income” refers to Line 37 on IRS Form 1040:

The SEE THE FUTURE Fund’s “Tools for Life” selection committee will review all applications.  Individual phone interviews may be arranged and will be determined on an individual basis.

Appropriate Sources for recommendation for the “Tools for Life” program: 

Having a student evaluated by an appropriate professional is critical for the success of the technology for the student.  A statement or report from at least one of the resources below needs to be included with the application:

Please note: Assessments by the professionals listed below need to have been performed within two calendar years of the date of application.

1.      The Colorado Low Vision Evaluation Clinic (Discuss with your child’s Teacher of the Visual Impaired (TVI))

2.      Optometrist specializing in Low Vision care (Click to see list of Providers)

3.      Teachers of the Visually Impaired (TVI’s).

4.      Certified Sales Representatives in conjunction with the low vision optometrist or the TVI: Most, if not all, technology is supported by a sales representative.  This representative is able to demonstrate the latest technology to the student and the optometrist or TVI is then able to determine the functional outcome for the student.  

Selection Process:

Applications will be reviewed by the “Tools for Life” Selection Committee and applicants will be informed of the committee’s decision by May 30th.  Students who are denied will be kept on a “wait list” and re-evaluated when appropriate funding is available.

Payment, Ordering, Delivery, & Training:

The SEE THE FUTURE Fund will inform the applicant via mail or email if they will receive the requested adaptive technology.  Payment by the family must be received by the SEE THE FUTURE Fund prior to ordering the device. 

The SEE THE FUTURE will order the device and coordinate with the family and TVI the location of delivery.  Sales representatives may be contacted to assist in dispensing & training of the adaptive device. 

The SEE THE FUTURE Fund is not responsible for providing training with the adaptive technology.  The SEE THE FUTURE Fund will be available to assist in locating professionals who may assist in the training process. 

The recipient and his/her family will own the equipment.  All warranties and repairs are the responsibility of the recipient and are not, in any way, the responsibility of the SEE THE FUTURE Fund.  

Receiving Family Contribution in a timely manner:

If the SEE THE FUTURE Fund does not receive the family contribution within 6 months of the May 30^th notification date, the scholarship will be forfeited and the family will need to reapply unless the family has requested and received an extension by the “Tools for Life” Selection Committee.

To apply to the SEE THE FUTURE “Tools for Life” Program please complete this application form (typewritten or printed legibly) and send, along with required attachments to:

The SEE THE FUTURE Fund
P.O. Box 63022
Colorado Springs, CO 80962-3022
You may fax applications or questions to: 719-471-3210

* MUST BE POSTMARKED OR RECEIVED BY April 15, 2009

Student Name:        

Date: 

Grade:  

Home address:

City:                                       State:

 Zip: 

Home Phone:                     

School Phone:

Email Address:

Parent/Guardian Name:       

Address same as above?     Yes             No

If No: Address:                          

Phone:

City:                                    

State:                 Zip:

Parent / Guardian Email Address: 

Teacher of the Visually Impaired (Vision Teacher):

Name of Technology Requested:

Company / Manufacturer:

Estimated Cost of Technology:

Father’s 2008 Adjusted Gross Income (Line 37 on IRS Form 1040:                           

Mother’s 2008 Adjusted Gross Income (Line 37 on IRS Form 1040:

Legal Guardian(s) 2008 Adjusted Gross Income (Line 37 on IRS Form 1040:    

 Student receives Medicaid?                  Y       N

Student receives Foster Car Subsidies? Y    N       If yes: $         per year

Please include the following with your SEE THE FUTURE Fund’s “Tools for Life” application:

1.                  Completed application form

2.                  Letter written by student stating his/her need of acquiring the technology.  No shorter than one paragraph and no longer than one type written page (for 3^rd grade and above).

3.                  Letter written by parent or guardian stating why their child is in need of this technology (one paragraph to one page maximum).

4.                  Letter written by Teacher of the Visually Impaired) stating why the student is in need of this technology (one paragraph to one page maximum).

5.                  Documentation by an appropriate source (see list below) that the equipment was assessed and beneficial for the students educational needs.

6.                  Copy of your IRS 1040 Form (1st two pages) for the previous year (2008).   Please include a 1040 for each parent or guardian who financially supports the student.  Please Note: Strict privacy will be maintained by the Selection Committee.

7.                  Letter from an Eye Care Professional stating medical visual condition and includes a diagnosis, prognosis, and current visual acuity.

Appropriate Sources for Recommendation of “Tools” (A statement by at least one of the following needs to be included with application to satisfy #5 above): 

  Please note: Assessments by the professionals listed below need to have been performed within two calendar years of the date of application.

1.      The Colorado Low Vision Evaluation Clinic (Discuss with your child’s Teacher of the Visual Impaired (TVI))

2.      Optometrist specializing in Low Vision care (see attached list of Providers)

3.      Teachers of the Visually Impaired (TVI’s).

4.      Certified Sales Representatives in conjunction with the low vision optometrist or the TVI: Most, if not all, technology is supported by a sales representative.  This representative is able to demonstrate the latest technology to the student and the optometrist or TVI is then able to determine the functional outcome for the student.

Complete application must be received or postmarked April 15, 2009

Applications will be reviewed by the “Tools for Life” Selection Committee and applicants will be informed of the committee’s decision by mail or email no later than May  30, 2009.

Receiving Family Contribution in a timely manner:

If the SEE THE FUTURE Fund does not receive the family contribution within 6 months of the May 30^th notification date, the scholarship will be forfeited and the family will need to reapply unless the family has requested and received an extension by the “Tools for Life” Selection Committee.