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Program Request

Request for Prevention Program

To request a vision screening or education program for your school or organization please provide the following information. Once submitted, the form will be sent to the PAB Member Agency serving the county listed.

The county where the school/organization/event is located.
Type of Program(Required)
The type of program you are requesting. You may make more than one selection.
Age Range(Required)
Please select the age range of the children. Please select only one option.
Date Requested(Required)
During which month(s) would you like this program to occur?
Please share any information about your school or event which you feel we should know.
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Phone: (717) 766-2020

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Pennsylvania Association for the Blind