Apply for a Radio : Ways to Listen : Radio Talking Book Services

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

First Name

Last Name

Phone

Date of Birth

Street Address

City

State

Zip

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.

Applicant's Signature

Preferred Format for Programming Schedule

Do you have internet access or wifi?

Do you have an Alexa device or other smart speaker?

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.

Full Name

Title

Organization

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Telephone

Email Address

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

Contact Person #1

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

Contact Person #2

Apply for a Radio

Apply for a Radio: Individual Application

Contact Information

Eligibility Requirements

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

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