New York State Education Department 

Office of Adult Career and Continuing Education Services-Vocational Rehabilitation (ACCES-VR) 

 

2014-15 STUDENT APPLICATION for READERS AID PROGRAM FUNDS 

Name (Last, First, Middle Initial): 

 

 

 Social Security Number 

 

 (last 4 digits) - __ __ __ __ 

 

Permanent Home Address: 

 

 

Name of Institution of Higher Education: 

 

 

Address of Institution of Higher Education: 

 

Are you matriculated in a Degree program or working 

toward a Certificate through an Institution of Higher Education? . Yes . No 

 

 

Are you affiliated with either of the following New York State Agencies? 

 

Office of Adult Career and Continuing Education Services-Vocational Rehabilitation 
(ACCES-VR) 

 

. No . Yes _____________________________ - _____________________________ 

 (If YES, print your counselor's name) (if YES, print your counselor's location) 

 

Commission for the Blind and Visually Handicapped (CBVH) 

 

. No . Yes _____________________________ - _____________________________ 

 (If YES, enter your counselor's name) (if YES, enter your counselor's location) 

 

 

I am attaching the following Blind or Deaf Proof of Disability (POD): For Legal Blindness and/or 
Deafnes 

 

. CBVH certification number: _________________ 

 

. Medical eye report from certified ophthalmologist 

 

. Audiogram from certified otologist indicating air and bone conduction thresholds 

 

. Other (Note type, e.g. Doctor’s Statement) ___________________________________________ 

 

Applicants Certification 

 

 

Signature: _______________________________ 

 

 

Date: _______________________________ 

 

 

Return completed form to your: Institution of 
Higher Education Student Disabilities 
Services Coordinator 

 

For information contact: Dennis Barlow 

(518) 474-7343 
dbarlow@mail.nysed.gov 

 

 NYS Readers Aid Program 

 NYS Education Department – ACCES-VR 

 99 Washington Avenue, Room 1605 

 Albany, New York 12234