Home Stay Program Application

Braille
ExcellentGoodSatisfactoryPoorNone

Mobility with the White Cane
ExcellentGoodSatisfactoryPoorNone

Cooking
ExcellentGoodSatisfactoryPoorNone

Technology using speech output
ExcellentGoodSatisfactoryPoorNone

Life skills such as budgeting and time management
ExcellentGoodSatisfactoryPoorNone

Are you prepared to commit to a 8-16 week program? (required)
YesNo

Are you prepared to wear learning shades during your training sessions? (required)
YesNo

Your training is free of charge, but accommodations will cost $125 per week. Would you require subsidy?
YesNo