White Cane Program Application

Program Guidelines

MCB provides one cane per year to qualifying blind Missourians:

MCB Members:

First request: graphite folding cane in requested length (unless a one-piece fiberglass or blind support cane is requested)
Subsequent requests: one-piece fiberglass cane or blind support cane

Non-Members:

One-piece fiberglass cane in requested length, or blind support cane

Important: You must submit written verification of legal blindness from an ophthalmologist or other reasonable authority (obtained within the past year), including a description of your eye condition, visual acuity, and field of vision. Fax to (314) 832-7796 or email aa@moblind.org.

White Cane Program Details

Required field

Personal Information

First Name

Last Name

Phone

Mailing Address (where to send your cane)

Address Line 1

Address Line 2

City

State

ZIP Code

MCB Membership

Are you a member of MCB?

Yes

MCB Affiliate Type (check all that apply)

Regular Affiliate

Special Affiliate

Member at Large

Which affiliate do you belong to?

Cane Request

Is this your first cane request from MCB?

Yes

Length of Cane

Cane Type (MCB members: first request defaults to graphite folding)

Documentation required: Submit written verification of legal blindness (from an ophthalmologist or other reasonable authority, obtained within the past year). Fax: (314) 832-7796 or email: aa@moblind.org.

Download a Form

Printable PDF (PDF, 33 KB)Word Document (Word, 47 KB)

Fill in the Word document on your computer and email it to aa@moblind.org.

Mail to:

Missouri Council of the Blind
5453 Chippewa Street
St. Louis, MO 63109

White Cane Day

MCB celebrates White Cane Safety Day on October 15 each year, recognizing the independence and achievements of the blind community.

Need Assistance?

(314) 832-7172

(800) 342-5632

moblind@moblind.org

Fax: (314) 832-7796