Eyeglasses Request

Vision Assistance Application

If you can't afford vision exams and/or eyeglasses, the Champaign Lions Club Vision Assistance Program may be able to help you pay for them.

If you are eligible for Medicaid, please try to get eyeglasses through that program. Optometry offices that accept Medicaid:
- The Eye Center, 2151 South Neil, Champaign. 217-352-2020
- Bard Optical, 907 Marketview Drive, Champaign. 217-351-8822

You must be a resident of Champaign County, Illinois to qualify for the Champaign Lions eyeglasses program.

Here are the steps involved in the Champaign Lions Eyeglasses program:

1. Fill out the form below with your contact information and a description attesting to your financial need.
2. Click Submit
3. Someone will contact you and tell you whether you qualify for the assistance and give you instructions for getting the eye exam and the eyeglasses.

* Indicates required field

Are you eligible for Medicaid? *

Name *

First

Last

Date of Birth *

Street Address *

Phone number *

Email *

Why do you need financial assistance? Include information about any vision insurance. *

Describe your vision problems *

Submit