Blind People in Charge Application Name (required) Address (required) Phone (required) Email (required) Date of Birth (required) How much remaining vision, if any, do you have? (required) When did you start experiencing significant vision loss? (required) Describe your current skill level in the following areas. (required) Braille ExcellentGoodSatisfactoryPoorNone Mobility with the White Cane ExcellentGoodSatisfactoryPoorNone Cooking ExcellentGoodSatisfactoryPoorNone Technology using speech output ExcellentGoodSatisfactoryPoorNone Life skills such as budgeting and time management ExcellentGoodSatisfactoryPoorNone How would you describe your general health? (required) Please describe any other disabilities or health conditions you experience, besides vision loss. (required) Are you prepared to commit to attending the centre at least one day (6 hours) per week? (required) YesNo Are you prepared to wear learning shades during your training sessions? (required) YesNo How did you hear about our program?