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Application Instructions & Forms

Educational Services for Blind and Visually Impaired Children - Application child with book (braille).Upon receiving a referral, a supervisor will review the packet to ensure it is complete and contains an eye report by an optometrist or ophthalmologist. Once complete, the student will be referred to a Teacher of Blind & Visually Impaired Children (TVI) from ESBVIC who will conduct an assessment of functional vision, analyze the students current learning media, review the educational implications of the visual impairment, and present recommendation for services to the IEP, 504 or IFSP team.

If services are needed, the type and amount of services are identified in the Individualized Education Plan (IEP) or the 504 Plan. Recommendations for the type and amount of services from ESBVIC for pre-school children are identified in the Individualized Family Services Plan (IFSP).

Please complete and return ALL of the following documents to ensure your application process moves as quickly as possible:

  • Completed and signed application packet (PDF)

  • A recent medical eye report from either an optometrist or ophthalmologist

    Please note: We must receive the medical eye information prior to any student visit.  If you do not have an eye report, ESBVIC will request the report but you should be aware it may affect how quickly we are able to complete the evaluation.  Please make sure all releases are signed and submitted with application.

CC MAine Education Services for Blind & Visually Impaired Children - ApplicationApplications may be faxed to: (207) 282-1694 or mailed to:

Nancy Moulton
ESBVIC Program Director
P.O. Box 645
Biddeford, ME 04005

If you have any questions, feel free to call us at 207-299-1936 or toll free 1-888-941-2855.