Colorado Center for the Blind

Take Charge with Confidence and Self-Reliance

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  • About the Center
    • Board of Directors
    • Directions to the Center
  • Our Programs
    • Independence Training Program for Adults
    • Youth Programs
    • College Prep
    • Senior Programs
    • Training for Professionals on Blindness
    • FAQ for Prospective Students
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  • You have reached this page in error.

    This form can only be accessed with a custom link, which you clearly don’t have. If you are interested in applying for our Summer Youth Programs, please contact Youth Services Director Anahit LaBarre at alabarre@cocenter.org for more information.
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     

  • Confirmation

  • Additional Info for Blank Contact

    This form is pre-populated with data for Blank Contact. Are you completing this form on behalf of Blank?

  • If you answered “No” above, Please contact Martin Becerra-Miranda at mbecerra@cocenter.org for more information.


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  • Student Information

  • When International Student is checked, all address and phone number fields will change to International format.
  • Medical History

  • Please check all that apply.
  • MedicationSymptoms of your allergic reactions 
  • Type of foodSymptoms of your allergic reactions 
  • You may add additional medications by clicking the plus sign at the end of the list.
    Medication NameDoseFrequencyReason for takingDate startedSelf administered?If No please explain 
  • You may add additional medications by clicking the plus sign at the end of the list.
    Medication NameTime to be TakenDosageSpecial Instructions 
  • Emergency Contacts

  • Emergency Contact #1

  • If no email exists for this person, please use the following for this required field:

    firstname.lastname@nomail.com

    Substitute the actual first and last name of the person.

  • Emergency Contact #2

  • If no email exists for this person, please use the following for this required field:

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    Substitute the actual first and last name of the person.

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Find More Information on Our Site:

General:

  • Home
  • About Us
  • Blog
  • Board of Directors
  • Calendar
  • CCB in the Media
  • Contact Us
  • Directions to the Center
  • Donate
  • Newsletter
  • Staff Directory
  • Volunteer Opportunities

Our Programs:

  • FAQ for Prospective Students
  • Independence Training Program for Adults
    • Braille
    • Cane Travel
    • Challenge Recreation
    • College Prep
    • Computer & Adaptive Technology
    • Discussion Groups on Blindness
    • Employment & Career Development
    • Home Management
    • Woodshop & Home Maintenance
  • Senior Programs
  • Training for Professionals on Blindness
  • Youth Programs

For VR Counselors:

  • Counselor Referral Forms

Contact the Center:

Email: ccb@cocenter.org

Phone: 303.778.1130 

Fax: 303.778.1598

2233 West Shepperd Ave
Littleton, CO 80120

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