From: patt@squid.tram.com (Patt Bromberger)
Newsgroups: misc.handicap
Subject: Application for Service : Recording For The Blind
Summary: Electronic Books
Keywords: Electronic Books
Date: 31 Aug 92 21:01:17 GMT
Reply-To: patt@squid.tram.com (Patt Bromberger)
Organization: Tramway Unix Systems
X-Fidonet: None

Index Number: 24091

This information is provided with the permission of
Mr. John Churchill
Vice President, Production

Recording for the Blind
20 Roszel Road
Princeton, New Jersey 08540

(609) 452-0606 . FAX (609) 987-8116
For book orders and inquiries,
call toll free, (800) 221-4792

                       APPLICATION FOR SERVICE

What is Recording for the Blind?  Recording for the Blind, or just
"RFB," is a nonprofit service organization that provides
recorded educational books and related library services to people
with print disabilities.  RFB has an extensive free library of
books on audio cassette and a recording service for new titles.  An
additional service is E-text -- books on computer disk, which are
available for purchase.

What types of books are available?  On audio cassette, we record
educational and professional books in all subjects and at all
academic levels from 4th grade through postgraduate studies.  These
include textbooks, research materials, and a variety of computer
manuals, as well as fiction, drama, and poetry in a number of
languages.  Our E-text collection contains primarily computer
titles, including software documentation.   Selected reference and
law books are also available.

Who uses RFB?  We serve students of many ages as well as people
no longer in school who use educational books to pursue careers
or personal interests.  The only requirement is a documented print
disability - blindness, low vision, learning disabilities,
or other physical impairments that affect reading.

What does it cost?  To become a member of RFB, include a one-time
registration fee of $25 (U.S.dollars) with your application.  The
fee may be paid by check, money order, MasterCard, VISA, or with an
institutional purchase order.  Please make checks or money orders
payable to "RFB".

Do I need special equipment?  Yes! RFB's taped books require a
cassette player that will play 4-track, 15/16 ips (inches per
second) tapes.  Ask us about our current models and distributors.
Our E-text books require a personal computer -- IBM or compatible,
Apple, or MacIntosh.

May I copy the tapes or computer disks?  No! All RFB's audio
cassette and E-text titles are produced with specific permission of
the publisher or copyright holder.  Our books are only to be used
by registered members of RFB and may not be copied or reproduced as
this would be in violation of these copyright agreements.

How do I find out more?  Ask for our booklet, "A Guide to
Using Recording for the Blind's Services."

                   PART I - APPLICANT INFORMATION

          Please complete the following for RFB's records.

               __ Miss
               __ Mrs.
               __ Ms.
               __ Dr.
Your name:     __ Mr.

________________________________________________________________
                        last            m.i.                 first

Date of birth:______________

Social Security number:____________________

Home address:

______________________________________

______________________________________

______________________________________
  city                 state  zip

______________________________________
 country

Mailing address:

______________________________________

______________________________________

______________________________________
  city                 state  zip
______________________________________
  country

Home telephone:(   )
Daytime telephone:(   )

Are you presently a student? _____yes ______no (if no, please skip
to Part II)

Please indicate the type of school
you are attending:

___ Elementary, Middle, or
    Intermediate
___ High School (9-12)

___ Vo-Tech School or Technical College
___ College or University (undergraduate)
___ Graduate or Professional School
Name and address of your school:

____________________________________________

____________________________________________

____________________________________________
  city                       state   zip

For K-12 students:

Name of your parent(s) or guardian(s):

______________________________________
last                    first    m.i.

Does your school have an Individualized
Education Program (IEP) for you? ___yes  ___no

For college or graduate students:

What is your major(s) or field(s) of study?
___________________________________________

___________________________________________

                        PART II - DISABILITY VERIFICATION

Please complete one of the following sections: "Blindness/Visual
Impairment," "Specific Learning Disability," or "Other Physical
Impairment or Print Disability."  This information is important to
us for statistical purposes. (If you have multiple disabilities,
please complete all sections that apply.)

BLINDNESS/VISUAL IMPAIRMENT

Please check one:  ___ legal blindness  ___ other visual
impairment

Do you read braille?  ___ yes  ___ no

Primary cause (please check one):
___ albinism
___ amblyopia
___ cataract
___ diabetic retinopathy
___ diplopia
___ glaucoma
___ injury to eye
___ macular degeneration
___ nystagmus
___ optic atrophy
___ retinal detachment
___ retinitis pigmentosa
___ retinopathy of prematurity
___ Stargardt's syndrome
___ strabismus
___ trauma (closed head)
___ tumor
___ other - please describe:_____________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

                                                    2

                                      SPECIFIC LEARNING DISABILITY

Please indicate tests that were used in the assessment process to
identify a specific learning disability.  At
least one test in each area should be checked.  If a relevant test
or segment of the assessment process is not
reflected here, please check "other" and describe the instrument
used.

1.   Intellectual Assessment
        ____Kaufman Assessment Battery for Children (K-ABC)
        ____Leiter International Performance Scale
        ____Stanford-Binet Intelligence Scale: Fourth Edition
        ____Wechsler Adult Intelligence Scale-Revised (WAIS-R)
        ____Wechsler Intelligence Scale for Children-Revised
(WISC-R)
        ____Woodcock-Johnson Psycho-Educational Battery, Part
I-Cognitive Ability (WJPEB-1 or WJ-R-COG)

____other:________________________________________________________
2.      Information Processing
        ____Bender Visual Motor Gestalt Test
        ____Benton Visual Retention Test
        ____Detroit Tests of Learning Aptitude
        ____Halsted-Reitan Neuropsychological Test Battery for
Adults
        ____Modern Language Aptitude Test (MLAT)
        ____Slingerland Screening Tests
        ____Wechsler Adult Intelligence Scale-Revised (WAIS-R)
        ____Wechsler Intelligence Scale for Children-Revised
(WISC-R)
        ____Woodcock-Johnson Psycho-Educational Battery, Part
I-Cognitive Ability (WJPEB-1 or WJ-R-Cog)

____other:_______________________________________________________

3.      Achievement
        ____Brigance Diagnostic Inventory of Essential Skills
        ____Gray Oral Reading Tests-Revised
        ____Kaufman Assessment Battery for Children (K-ABC)
        ____Peabody Individual Achievement Test (PIAT)
        ____Peabody Picture Vocabulary Test-Revised (PPVT-R)
        ____Spache Diagnostic Reading Scales
        ____Stanford Diagnostic Reading Test (SDRT)
        ____Stanford Test of Academic Skills (TASK)
        ____Test of Reading Comprehension (TORC)
        ____Test of Written Language (TOWL)
        ____Wide Range Achievement Test-Revised (WRAT-R)
        ____Woodcock-Johnson Psycho-Educational Battery, Part
11-Tests of Achievement (WJPEB-11 or WJ-R-Ach)

____other:______________________________________________________

Name and professional capacity of person who administered testing:

_________________________________________________________________
_________________________________________________________________

_________________________________________________________________
_________________________________________________________________

Please describe how disability limits your ability to read:

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

                    OTHER PHYSICAL IMPAIRMENT OR PRINT DISABILITY

Primary cause (please check one):
____arthritis

____cancer

____cerebral palsy

____epilepsy

____head injury
____multiple sclerosis
____other neurological disorder
____quadriplegia
____spina bifida
____stroke
____other print disability - please
describe:________________________________________________________
_________________________________________________________________
_________________________________________________________________

Please describe how disability limits your ability to read:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
__________________________________________________________________
__________________________________________________________________

                                        PART III - CERTIFICATION

Option I
Please have certification completed by a professional in disability
services, education, medicine, psychology,
or a related area.

                                                 - or -
Option 2
If you are receiving services from a cooperating network library
for the blind and physically handicapped, attach
a copy of a mailing label from any book, catalog, or magazine that
you have received from this service.  We will
accept it in place of the information requested below.

For applicants in Canada or the United Kingdom: if you are
registered with the Canadian National Institute for
the Blind (CNIB), Crane Memorial Library of the University of
British Columbia, or the Royal National Institute
for the Blind (RNIB), you may send similar proof of registration
with them in place of the information requested
below.

I certify that the information provided on this application is
accurate.

Name of Certifying Professional:___________________________________

Professional Capacity:_____________________________________________

Place of Employment:_______________________________________________
Street Address:____________________________________________________

City:___________________________

State:___________

Zip:__________

Daytime Telephone:(   )

Signature:_________________________________________________________

                ___________________________________________

Thank you for completing RFB's application.
We hope to be of service to you soon!

 Rev.
12/91

--
Patricia Ann Bromberger                     -       patt@squid.tram.com
Tramway Unix Systems
"Practice random kindness and senseless acts of beauty." (Anne Herbert)