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Technology Empowering Choice & Hope

V360 TECH Community Interest Form

Thank you for your interest in the V 360 TECH (Technology Empowering Choice & Hope) at Lions Services. V360 TECH provides assistive technology training and digital skills support for individuals who are blind or have low vision. Please complete this form and a member of our team will follow up with you.

Contact Information

What is your date of birth? (optional) For example: 4 27 1990. You may leave this blank.
Preferred Method of Contact (required)
Best Time to Contact You (select all that apply)

Program Interest

Are you completing this form for yourself or someone else? (required)
Are you blind or do you have low vision? (optional)
What kind of support are you interested in? (select all that apply)
Are you currently receiving technology training somewhere else? (optional)
Did you ever serve in the military? (optional)
Are you currently working with DSB or another organization? (optional)
Are you a student? (optional)

Access and Support

Do you currently have access to a smartphone, tablet, or computer? (select all that apply)
Do you need transportation assistance to attend in-person training? (optional)
Preferred Training Format (optional)

Consent

Your information is kept private and is used only to follow up with you about V360 TECH. See our Privacy Policy for details.