Apply to Life Launch at Perkins School for the Blind

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Student



ex: 1/2/2005






*To add additional family contacts use the "Add Another Family Contact" link below the first contact
Family Contact




must be unique for each contact

ex: ###-###-####

This must be the email address of one of the family contacts entered above.



(ex: Massachusetts Commission for the Blind, New England Consortium of Deafblindness, a state Deafblind Poject. etc)

(please describe briefly)

School District/Other Contact






ex: ###-###-####
Educational Information


(please describe)



Daily Living Skills

Social Skills

Behavior and Adjustment


Communication



Orientation and Mobility

Medical Information

Vision and Hearing Impairment
Vision Information


Visual Acuity










Hearing






Amplified Devices





Other Thoughts

File Upload 


Submit application materials here or by mail, email, or fax. 


File types that can be uploaded for documents:

  • .doc (Older Microsoft Word format)
  • .docx (Current Microsoft Word format)
  • .pdf (Adobe PDF)
  • .odt (Open Office word processor document)
File types that can be uploaded for images:
  • .bmp (Bitmap)
  • .gif (Graphics Interchange Format)
  • .jpg (Joint Photographic Experts Group)
  • .jpeg (Joint Photographic Experts Group)
  • .png (Portable Network Graphics)
  • .tif (Tagged Image File)
Image Upload

Help us to know our applicants better.

File types that can be uploaded for images:
  • .bmp (Bitmap)
  • .gif (Graphics Interchange Format)
  • .jpg (Joint Photographic Experts Group)
  • .jpeg (Joint Photographic Experts Group)
  • .png (Portable Network Graphics)
  • .tif (Tagged Image File)
Permission and Privacy Statement

If you have applied to Perkins within the last 6 months, please contact our office before submitting any documents other than this application.