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 have a Illinois Medical card or vision insurance, please get eyeglasses using those, since the Champaign Lions have limited funds.

Optometry offices that accept Medicaid:
- Eye exam: The Eye Center, 2151 South Neil, Champaign. 217-352-2020
- Eyeglasses: Walmart Optical
- Eye exam and/or eyeglasses: Bard Optical, 907 Marketview Drive, Champaign. 217-351-8822

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

Champaign Lions will only pay for basic, plastic, uncoated single-vision or bifocal eyeglasses.

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. Please wait for this contact before proceeding.

* Indicates required field

Do you have a Medicaid Medical card or vision insurance? *

If you answered YES above, why do you need eyeglasses through the Lions Club? *

Name *

First

Last

Date of Birth *

Street Address *

Phone number *

Email *

Please describe your financial situation. *

Submit