Listener Application

Apply Today!

Signing up helps us obtain funding to continue providing free services. Apply for free programming, services, and equipment by filling out the form below.

If you prefer to fill out a paper application, download and print this version and send to 1700 55th st., Suite A, Boulder, CO, 80301.

  • Contact Information

  • Nombre
  • Comunidad
  • Condado
  • Casa
  • Móvil
  • Oficína
  • Correo electrónico
  • Eligibility Requirement (Eligibilidad)

    AINC services are intended solely for people who are blind, visually impaired, or print disabled.
  • Perdida de la vista
  • Otro impedimiento (especifique)
  • Demographic Information

    Funding agencies ask for data on who we serve. AINC provides summaries of this anonymous data only to authorized funders.
  • Género
  • Fecha de nacimiento
  • Hidden
    Raza/Etnia
  • Idioma preferido
  • # personas en casa
  • Cabeza de hogar mujer
  • Veterano
  • Ingreso familiar
  • ¿Tiene Internet?
  • Fuente de referencia
  • Contacto alterno
  • Teléfono
  • Correo electrónico
  • AINC regularly mails out programming schedules and other information. There are several formats that we can send information in. Select all of the formats that are acceptable.
  • Hidden
  • Hidden
  • Hidden
  • Notas
  • We would like to send occasional news from the Audio Information Network of Colorado. To join our emailing list, simply check the box below. You can unsubscribe at any time.
  • This field is for validation purposes and should be left unchanged.

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