Emergency Disaster Relief Fund Application

About the Disaster Relief Fund

In times of crisis, community means everything. MCB's Emergency Disaster Relief Fund provides gift cards to eligible blind or visually impaired individuals who have been directly impacted by a declared emergency.

Each eligible blind person or MCB member in the affected area may receive one gift card per disaster occurrence.
MCB members: indicate your affiliate or Member at Large status.
Non-members: you must submit documentation of proof of blindness — fax to (314) 832-7796 or email aa@moblind.org.

Program Not Active

The Emergency Disaster Relief Fund is not currently active. MCB activates the program as needed. Please check back for updates or contact MCB if you have questions.

Required field

Personal Information

First Name

Last Name

Phone

Mailing Address

Address Line 1

Address Line 2

City

State

ZIP Code

MCB Membership

Are you a member of MCB?

Yes

Affiliate or Member at Large (if MCB member)

Proof of Blindness Note (non-members only)

Non-members must submit documentation of proof of blindness. Fax: (314) 832-7796 or email aa@moblind.org.

Disaster Information

Current Disaster Occurrence

Date of Disaster

Most Urgent Needs

Food

Water

Shelter

Clothing

Blindness Equipment Lost/Damaged

Other (please explain below)

Other Need (if "Other" selected)

Explanation of Need

Paper Form

The Emergency Disaster Relief Fund Application is currently unavailable. Please check back for updates or contact MCB if you have questions.

Need Assistance?

(314) 832-7172

(800) 342-5632

moblind@moblind.org

Fax: (314) 832-7796