Below you will find the Jasper Lions Club Application for Eyecare and the Referral Form for Eyecare. Both documents are provided in English and Spanish to make the process as simple as possible.

• You, the applicant (or legal guardian), should complete the Application for Eyecare.
• Your eye care specialist or school administration must complete the Referral Form for Eyecare.
  (Please note: This form cannot be filled out by the applicant or the applicant’s legal guardian.)

If you have any questions regarding the application or referral form, please contact Joe Cozza at 812-631-3859

Please return the completed forms to:

Jasper Lions Club
P.O. Box 51
Jasper, IN 47547-0051