Application

The following states participate in the VISION USA program:  Alaska, Alabama, Arkansas, Connecticut, District of Columbia, Delaware, Florida, Georgia, Iowa, Idaho, Illinois, Indiana, Louisiana, Massachusetts, Maryland, Maine, Michigan, Missouri, Mississippi, North Carolina, Nebraska, New Hampshire, New Jersey, New Mexico, Nevada, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Vermont, Washington, and West Virginia.  If your state is not listed, see state run programs.

VISION USA APPLICATION WORKSHEET IS NOW AVAILABLE FOR DOWNLOAD

Download and print an application worksheet and deliver completed worksheet along with income verification documents to a charitable organization, social worker, case worker, community health agency for eligibility verification and online application submission:

• VISION USA Application Worksheet – English
• VISION USA Application Worksheet for New Jersey Residents
• VISION USA Application Worksheet – Spanish (Coming Soon)

All applications will be reviewed.  If an applicant is approved, the agency will receive an email notification of doctor assignment on behalf of the client. It is the agency’s responsibility to provide the doctor information to their client.  If you are not currently working with a case worker, see “Referral Agencies.”

Application worksheets are also available by sending a self-addressed stamped envelope to:

VISION USA
243 North Lindbergh Blvd.
St. Louis, MO 63141
Phone: 1-800-766-4466 (Automated System)
E-mail: visionusa@aoa.org

DO NOT MAIL OR FAX APPLICATIONS TO OUR OFFICES.  ALL APPLICATIONS “MUST” BE SUBMITTED ONLINE BY REFERRAL AGENCY.  SEE “REFERRAL AGENCIES” SECTION TO BECOME A REFERRAL AGENCY.