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SEE Program Application

Remember to send references to: Olmsted Center for Sight, Attn: SEE Program, 1170 Main Street, Buffalo, NY 14209.

Please complete the information requested below.

Application is being submitted by:
Please enter phone as ###-###-####

I. Personal Information
, :
 
Please enter phone as ###-###-####
Please enter cell as ###-###-####
 
Please enter date of birth as MM/DD/YY
 

Emergency Contact Information
, :
Please enter phone as ###-###-####
Please enter phone as ###-###-####
 
 

 

 

 

 



 





 
Please list the names and phone numbers of the rehabilitation professionals you are currently working with (for example: Special Ed teacher, TVI, Rehab Counselor, Caseworker, etc.):
Please enter phone as ###-###-####
Please enter phone as ###-###-####
Please enter phone as ###-###-####
 

II. Education and Employment Experience
 
Please enter phone as ###-###-####
 





 


 



 


 

 


 


 




 





 

 

Please answer the following questions so we can become familiar with your interests
 

 

 

 

Please send two letters of recommendation with your application. Letters of recommendation may be written by any of your teachers or a guidance counselor.