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Opportunity for blind middle school youth and their parents

Mission Believe Online Application

MISSION: BELIEVE The Sky's The Limit
Sponsored by the National Federation of the Blind of Missouri
July 25-27, 2008
Windermere Conference Center - Roach, Missouri

Note to Online Registrants:

Eligeability to participate in this event is limited to Missouri residents. If you submit your application online it is important to gather all pertinant information prior to entering the required data in to the form. Once begun you must complete all form fields. You cannot begin entering the form data and submitting additional information at a later time as all of the form entries will be lost once you exit the application. For this reason we strongly encourage you and your parents to gather all required information prior to filling out and submitting the online application.

Return profiles to:

National Federation of the Blind of Missouri
7928 NW Milrey Drive
Kansas City, MO 64152

Student Profile
Student's First Name:	Student's Last Name:
Gendor	Student's Birth Date	Student's Grade Level
First Name of Parent or Guardian	Last Name of Parent or Guardian
Address Line One
Address Line Two
City:	State:	Zip:
Home Phone Number:	Alternate Phone Number:	Email Address:
Please clearly describe any medical conditions or disabilities the student has, including cause of blindness, visual functioning (if any), any medications that will need to be taken during the event, and any other special considerations (medical or otherwise) of which we need to be aware.

Reading Media and School Information
Student's Reading medium:	School Name:
Has the student ever participated in a summer camp or blindness skills program?	If so, where and when?
On a separate sheet, please write a paragraph describing three goals you have set for yourself and why these goals are important to you. (To be completed by the student) If registering online you can use the text box below to include this information.

Parent Profile
Name of Parents/Guardian who will be participating in this event with this student:	Adult's Reading medium:
Please describe any special considerations (medical or otherwise) of which we need to be aware regarding the adults accompanying this student:
Register for Mission Believe

** Please note the following:

This form is the initial part of the application process and will be followed by a telephone interview with student and parents/guardian.
Accepted students and parent(s) must be able to attend the entire weekend activities.
Space will be limited to 16 students and their parents.
This program is being funded by grants and donations. There will be no cost to participants.

Additional Information

Return profiles to:

National Federation of the Blind of Missouri
7928 NW Milrey Drive
Kansas City, MO 64152

For more information contact Shelia Wright at 816-741-6402 or by email at firstvice.president@nfbmo.org

The National Federation of the Blind of Missouri wishes to thank Mr. Bob Trevithick of Williams New York for special assistance in designing the Mission Believe Online Application.

Opportunity for blind middle school youth and their parents

Student Profile

Reading Media and School Information

Parent Profile

** Please note the following:

Additional Information