"Moore Safe Nights"

Asterisk (*) indicates required field.

Applicant's Name & Address

*First Name:

*Last Name:

*Street:

*City:

*State:

KY residents only.

*Zip Code:

*County:

*Are you applying for this equipment for yourself or for someone else?

I am applying for myself I am applying for someone else

Applicant's Date of Birth

Note: Applicant must be 5 years of age or above.

*Date of Birth:

*Applicant's Contact Information

Note: Please indicate how you prefer to be contacted, if necessary. At least one of the following fields is required.

Phone:

Videophone:

Email Address:

Deaf or Hard of Hearing Verification

YOU MUST BE DEAF OR HARD OF HEARING TO APPLY FOR THIS EQUIPMENT.

*Have you received equipment from the KCDHH Telecommunications Access Program in the past?

Yes No

Form Validation

*Are you human?
What does

Once you receive your weather radio, the following videos will
help you with basic set-up and troubleshooting for common problems.

Basic Radio Set Up
Batteries, time, attachments, etc.Troubleshooting
Fixing common problems