Printable Application
SCA Radio - broadcast delivery of newspapers,magazines, books, grocery ads and more
Sun Dial II - telephone access to newspapers, radio reading broadcasts and other websites
HD Radio - Use your own HD radio to listen to Sun Sounds.
Online - Stream the live broadcast or listen to podcasts.
DTV - Digital television receivers available in some areas.
Cable TV - Some cable TV systems include Sun Sounds. Currently available in Yuma.
ELIGIBILITY -You are eligible for services from Sun Sounds of Arizona at no cost if you cannot read standard printed materials due to a disability.
VERIFICATION REQUIREMENTS - You must provide the name, title and phone number of a Verifying Authority such as a Doctor of Medicine, Osteopathy, Optometry, Ophthalmology, or a Registered Nurse or Professional Staff of a Medical Facility or a Public or Private Agency. Their signature is not required but we may contact them to verify your eligibility.
Other Resources? Check out sunsounds.org/resources section for a comprehensive listing of services and products to further enhance your independent living.
If you encounter difficulties with the application or have any questions, please call us at 480-774-8300 for more information.
SUN SOUNDS OF ARIZONA MEMBERSHIP APPLICATION (CONFIDENTIAL INFORMATION)
NAME ____________________________________DATE _____________
FACILITY NAME (if applicable) _____________________________
ADDRESS _______________________________________________
CITY ______________________ZIP____________
PHONE ______-________________
BIRTHDATE ____/____/_____
E-MAIL ____________________________________________
Delivery methods (Select at least one. Some methods may not be available
state-wide. Ask your affiliate for details.)
Sun Dial II (telephone) ______ Radio _______ Online________
HD Radio (use your own) ______ Cable TV _______ DTV________
BROADCAST SCHEDULE
Large Print_____Braille_____Audio CD_____Email____
Description of Disability __________________________________________
NAME and TITLE of verifying authority ___________________________
_______________________________________________________________
Referred by _________________________________
THIS SECTION APPLIES TO THOSE REQUESTING A RADIO
TWO CONTACT PERSONS, not living with you, must be provided:
These persons may be living outside of Arizona. They will only be contacted
if your mail is returned and you have not notified Sun Sounds of a new
address and phone number.
Name _______________________________ Phone _____-_______________
Name _______________________________ Phone _____-_______________
STATEMENT OF AGREEMENT & RESPONSIBILITY (RADIO SERVICE ONLY)
I understand that the Sun Sounds Radio receiver is on loan to me and
remains the property of Sun Sounds and must be returned when it will no longer
be used. I will pay Sun Sounds a $50 replacement fee if the receiver is not returned:
Signature of Responsible Party _______________________________
FOR OFFICE USE ONLY
Delivered _____ Mailed _____ RECV”r# _________ Freq________ DateRet'd____________
2ND#_________Freq__________Rec'd________Ret'd_____________
MAIL OR FAX YOUR APPLICATION TO THE NEAREST OFFICE:
2323 W. 14th Street, Tempe, AZ 85281
480-774-8300 Fax: 480-774-8310
7290 E. Broadway, Ste. 166, Tucson, AZ 85710
520-296-2400 Fax:520-298-6676
1300 S. Milton, Ste. 202, Flagstaff, AZ 86001
928-779-1775 Fax:928-226-1387
1931 S. Arizona Ave., #4 Yuma, AZ 85364
928-329-6681 x20
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