Online Application

What's On Now:
Women's Magazines

Local Date/Time: 05/13/2008 12:18 PM GMT-7

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Apply for Services

Sun Dial - telephone access to newspapers, radio reading broadcasts and other websites

Radio - broadcast delivery of newspapers, magazines and books

ELIGIBILITY -You are eligible for services from Sun Sounds of Arizona if you cannot read standard printed materials because of a visual disability or you have a learning or physical disability.

VERIFICATION REQUIREMENTS - You must provide the name, title and phone number of a Verifying Authority such as a Doctor of Medicine, Osteopathy, Optometry, Ophthalmology, or a Registered Nurse or Professional Staff of a Medical Facility or a Public or Private Agency. Their signature is not required but we may contact them to verify your eligibility.

Other Resources? Check out sunsounds.org/resources section, for a comprehensive listing of services and products to further enhance your independent living.

Online Application

Step 1: Fill Out Form

Personal Information (CONFIDENTIAL)

* Required fields
*	Service Requested:	Sun Dial Radio Both (no charge)
*	Name:

* Date of Birth:
	Facility Name:
*	home/business name and address:
*	city:
*	state:
*	zip code:
*	Email:
*	Phone:
	Referred By:

Additional Contacts

THIS SECTION APPLIES TO SUN SOUNDS RADIO SERVICE ONLY TWO CONTACT PERSONS - NOT LIVING WITH YOU MUST BE PROVIDED: These persons may be living outside of Arizona- They will only be contacted if your mail is returned and you have not notified Sun Sounds of a new address and phone number.
*	First Contact Name:
*	First Contact Phone:
*	Second Contact Name:
*	Second Contact Phone:

Additional information

* PROGRAM SCHEDULE (TELLS YOU WHAT TIMES PROGRAMS ARE AIRED) Preferred Format: Large Print Braille Cassette Tape Disk
* * Name of Physician / Competent Authority:
STATEMENT OF AGREEMENT & RESPONSIBILITY (RADIO SERVICE ONLY) I understand that the Sun Sounds Radio receiver is on loan to me and remains the property of Sun Sounds and must be returned when it will no longer be used. I will pay Sun Sounds an $35 replacement fee is the receiver is not returned. * Name of Responsible Party:

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Sun Sounds of Arizona is a service of Rio Salado College and Maricopa Community Colleges.

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