Massachusetts Commission for the Blind

Are you requesting an MCB Identification Card?(Required)

Yes

Are you requesting a Certificate of Blindness?(Required)

Yes

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Date of Birth(Required)

Height(Required)

Sex(Required)

Male

Female

Other

Please upload a 2” x 2” photo of yourself.(Required)

Drop files here or

Max. file size: 50 MB.

Please upload a file of your signature.(Required)

Drop files here or

Max. file size: 50 MB.