	"Serving the Blind and Low Vision of Montana Since 1947"

SOP Form Part 1

This is an application for the Montana Association for the Blind’s Summer Orientation Program for the Blind and Partially Sighted (SOP). It is in three parts:

Part 1 Application for Enrollment to be completed by the applicant and returned by Monday, April 15, 2024 for best consideration.

This can be turned in before Parts 2 and 3 are submitted. Applications received after that will be considered as well depending on space.

Part 2 – A current Physical Examination Report to be completed by your physician, and returned before Monday, May 6, 2024.

Part 3 – A current Visual Examination Report from your eye doctor. A visual exam must be completed within the past 12 months and submitted before Monday, May 6, 2024.

Your name and address must be complete on each form.
All blanks must be completed on each form.
Montana Association for the Blind
1802 W. Park
Anaconda, MT 59711

Students are responsible for their routine medical care. A part-time medical aid is available to assist with medication if needed. If an emergency arises or any sterile treatment is needed, we must call an ambulance to transport the student to the hospital. Students must bring the medication they will need to the program. This year's program will be at the Ursuline Center campus in Great Falls, Montana. Classes are scheduled to be held from Monday, June 3 through Friday, June 28, 2024. There is no charge for accepted students. The MAB will provide room and board and necessary equipment for student training. The student must provide food supplements and medical supplies. Students who own adaptive equipment on which they would like to receive training are welcome to bring such items to the program.

All students are required to take Activities of Daily Living (ADL), group discussion, and Orientation and Mobility (O & M). Students then may choose from other classes available classes: low vision aids, Braille, computers, keyboarding, cooking, workforce skills, crafts, exercise, smart technology, sewing, and woodworking.

PLEASE TYPE OR PRINT CLEARLY

Students accepted in this program will take classes determined by their interests, Montana Blind and Low Vision Services input, and the SOP committee. Class schedules will be presented on the first day of the program—no class changes will be allowed during the first week.

Punctual attendance of all classes that students are enrolled in is required for successful completion of this program. We may add or subtract classes depending on student needs.

Please return Part 1 by the April 15, 2024 deadline even if the medical and visual forms are not immediately available. Please return the medical and visual forms as soon as possible. We would appreciate having the application information typed or clearly printed if possible.

If you have any questions, you may contact:
Montana Association for the Blind
1802 W. Park
Anaconda, MT 59711
Phone: (406) 442-9411

Please share this letter with your physicians.
Sincerely,
Summer Orientation Program Committee

2024 SUMMER ORIENTATION PROGRAM for the Blind and Partially Sighted
Sponsored by the Montana Association for the Blind, Inc.
Mail completed application to:
MAB
1802 W. Park
Anaconda, MT 59711
Or submit to: mabadmin@mabsop.org

Part 1 - Personal Information:
Please Type or Print Clearly

SOP Form Part 1

First Name

Last Name

Address

City

State

Zip Code

Phone

email *

Date Of Birth

Age

Are you a Veteran?
Yes
No

Medicare Number

Do You Have Part B:
Yes
No

Medicaid Number

Other Health Insurance and Number:

Primary Insurance Carrier:

Sex:
Male
Female

Have you had your 2 COVID-19 shots (required for attendance):
Yes
No

List your primary medical doctor & phone number:

Do you have any allergies?
Yes
No

If Yes, Please list them:

Emergency Contact: Name/Phone

Relationship

Work Experience

What are your Hobbies/Interests?

Have you attended a previous session of the MAB's Summer Orientation Program?
Yes
No

If Yes, When?

What caused your Vision loss?

Date of Onset:

Describe Your Vision?

Do you have any disabilities and/or medical conditions other than your visual impairment?
Yes
No

Other Disability

Do you have hearing loss?
Yes
No

Do you use hearing aids?
Yes
No

Are you a client of the State of Montana Blind and Low Vision Services?
Yes
No

Name of Counselor:

Can they be contacted?
Yes
No

Have you been issued a white cane?
Yes
No

If yes, have you received training in the use of the white cane?
Yes
No

Do you use any aids to walk other than for your visual impairment?
Yes
No

Do you require supplementary oxygen?
Yes
No

Do you require a breathing apparatus at night for sleeping?
Yes
No

Are you fit enough to walk 4 blocks without physical assistance from another person?
Yes
No

Do you rely upon any other physical apparatuses?
Yes
No

If Yes, Please explain what you use.

Are you a Diabetic?
Yes
No

If yes, is your Diabetes controlled with Insulin injections or by oral preparation or by both or by diet only?
Insulin Type
Oral
Both
Diet Only

Are you currently driving a vehicle?
Yes
No

If Yes, Explain

Type the above number:

Stay Connected:

Would you like to Volunteer?

If you want to be a volunteer, please contact us at: (406) 442-9411.

You can also Open and Fill out the Volunteer form but you must contact us before you can volunteer. All volunteers must be screened and approved before they can participate.

Open the Volunteer Form

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Montana Association for the Blind -Forms

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Accessible Form

SOP Form Part 1

SOP Form Part 1

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Would you like to Volunteer?

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Accessible Form

SOP Form Part 1

SOP Form Part 1

Stay Connected:

Would you like to Volunteer?

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