Paperwork for Requesting Eye Glasses Assistance

Please download all three of the following documents and read them carefully.

Follow all instructions and make sure to fill out the application completely.

Proof of income and any other information that will document your financial situation MUST be submitted with the application form. Co-payment must also be submitted at the same time as well.

1. Instructions

2. Application for Eye Glass Assistance

3. Sight Guidelines


If you have any questions, you can contact the Lions 26-M2 Hotline at