Blind Faith Services
Please use this form to request services from our Blind Faith program. Depending on circumstances, documentation will be required. Please allow 5 – 10 business days for approval or denial.
For additional services or request that is not listed here, please contact
Address (include City, State, and Zip Code)
Services you are requesting:
Medical Services (example: co-pay)
SSI / SSDI
Counseling / Coaching Services
If you are requesting funds, you must meet certain criteria and submit the following for review:
Copy of appointment card / letter with Physician(s)
State ID / Driver's License
Proof of Income (pay stub, letter from employer, SSI award letter)
Proof of residency (if you are homeless, copy of letter from the shelter)
Thank you for contacting the Blind Faith Program
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