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Apply for a Radio: Individual Application

To request a radio for an individual who has visual or physical disabilities that prevents them from reading, please fill out the form below. 

If you are requesting service for a facility, e.g. nursing home, hospital, senior center, please find the form HERE.

Please note radios are provided at no cost for eligible individuals and care facilities.  If you have questions about the application process, services offered, or eligibility requirements please call RTBS at (402) 572-3003 or email us at info@rtbs.org.

Contact Information

I am aware that the receiver is on loan to me and remains the property of the Radio Talking Book Service. If I move or change my telephone number, I will notify Radio Talking Book Service. If the receiver is no longer needed or used, I will return it to the Radio Talking Book Service.

Eligibility Requirements

You are eligible for services from Radio Talking Book Service at no charge if you cannot read printed materials due to a disability including but not limited to: blindness, visual impairment, physical disability, cognitive disability, etc.

Please provide contact information of a verifying authority such as a physician, nurse, counselor, clergy, or other qualified professional, or an officer of a public or private organization (such as the NCBVI, etc). Their signature is not required but we may contact them to verify your eligibility.

Contact persons should be someone with whom you regularly communicate and who know you have given us their name.
Please fill out both sections. This information is very important.

Please include your Name, Relationship, Address, Phone and Email Address
Please include your Name, Relationship, Address, Phone and Email Address