Application for O&M Immersion Program

Contact Information

Mailing Address
Contact Information
General Information





Guide Dogs for the Blind will consider applications from individuals with felony convictions on a case by case basic. 

Personal and Health Information

Legal blindness is defined as visual acuity of 20/200 or worse or a field restriction of 20 degrees or less in both eyes.




Rehabilitation Training


Travel Practices








Destinations

Although it is not required that you have established routes for the Immersion Program, Please list any routes that you do travel independently here for our reference.  If you have addresses for the destinations, please include that information.


For example, Home to Joe's Cafe at 1000 A Street.   

Optional Question Used For Statistical Purposes

Guide Dogs for the Blind, Inc. does not discriminate against any applicant for admission to our program based upon race, religion, color, national origin, ancestry, age, marital status, gender, or any other factor prohibited under local, state or federal laws. Any applicant denied admission may subsequently reapply and be reconsidered without prejudice.

Next Step


Immersion Program Understanding

The O&M Immersion is a six-day residential training program that requires sustained cognitive, physical, emotional. and social functioning.  Clients must be reasonably independent and demonstrate average tolerance to dormitory life.  Do you think you can cope with the stress of being in a new group environment along with learning and applying O&M skills for this time period?

___________________________________________________ I understand that completing this form places neither me nor Guide Dogs for the Blind under any obligation, but assists Guide Dogs for the Blind in determining my eligibility for the O&M Immersion.


Guide Dogs for the Blind, Inc. does not discriminate against any applicant for admission to the Guide Dog program based upon race, religion, color, national origin, ancestry, age, marital status, gender, or any other factor prohibited under local, state or federal laws.  Any applicant denied admission may subsequently reapply and be reconsidered without prejudice.  I hereby declare that the information given above is accurate to the best of my knowledge.

___________________________________________________  By submitting this application I understand that my application content, including professional reports, will be reviewed by the O&M Immersion Program staff and Admissions Review Committee. If accepted to train, the pertinent details from my GDB file will be shared with the partner agency and O&M specialist I am assigned to. This information is considered confidential and will not be shared outside of these parameters without my express written consent.