Untitled

Designation Form For Ex Officio Trustees of the American Printing House for the Blind, Inc.

This document designates the following person as the Ex Officio Trustee of the American Printing House for the Blind for the purposes of administering the federal Act to Promote the Education of the Blind. This designation will remain in effect until further written notice is presented to the American Printing House for the Blind.

Name of School, Educational Program, Agency, or State Department of Education:

Signature of Ex Officio Trustee: __________________________________________

Name of Ex Officio Trustee:

Title:

Mailing Address:

Phone: Fax:

E-Mail Address:

Reading Material Preference:
Print Large Print Braille CD

Name of Appointing Officer:

*Signature of Appointing Officer: _____________________________________

Title:

Date:

* The Ex Officio Trustee for an account is appointed by the head of each respective organization, as follows: head of the state department of education, superintendent of a residential school for the blind, or the executive officer of other agencies serving the blind.

Please fax a copy of the completed form to Cindy Amback at (502) 899-2363 and mail the hard copy of the signed document to: American Printing House for the Blind, Attn: Cindy Amback, 1839 Frankfort Avenue, Louisville, KY, 40206. Questions should be directed to Cindy at (800) 223-1839, ext. 257.