CIMC Forms

The forms and documents below are categorized by content area. Click on the desired document to download it to a computer. There will not be a 'preview' of the document. Open the document, complete all fields accurately, and save a copy before emailing the document to the appropriate CIMC email address indicated on the form.

Keep the originals of all signed forms on file in the Administrative Unit (AU) / school district / B.O.C.E.S. / agency and mail copies, as appropriate, to the CIMC.

For assistance, please call the CIMC pilot number at (719) 578-2196 or email the appropriate email account listed below under "Contact Us". Please note that the CIMC Pilot phone number does not have voicemail capability, but individual CIMC staff phone numbers do have voicemail capability.

We welcome feedback on the functionality of this page and our CIMC Forms. Please email or call the CIMC with all suggestions so we may continue to improve our services.

Infant Registration (birth through age 2)

Infant Registration Form (birth through age 2)

MDB/FDB Form (for birth through age 2)

 Parent Consent Form in English

Parent Consent Form in Spanish

Exit Form in Word format

Screen reading software users can access this Exit Form in plain text format

Fill out the Exit Form when the infant is no longer eligible for early intervention, withdraws from the agency, or ages out (on the day before their 3rd birthday). If the student will receive school-aged services, a new School-Aged Registration Form needs to be submitted on the student's 3rd birthday. See the School-Aged section below for the appropriate forms.

School-Aged Registration (ages 3-21)

 

The Registration Form is required for all students receiving vision services in your administrative unit

A change of placement to a new school district requires a new Registration Form

This Registration Form  (ages 3-21) in Word format lets you fill it out on your computer

Print this PDF version, with blank spaces, if you need to hand-write your Registration information

If you are using screen reading software, use this Registration in plain text format

The Parent Consent Form is required for all students registered with the CIMC.

Please be sure the district has replaced the original Parent Consent Form (with only one signature line) with the updated form which contains a "Part 1" and a "Part 2". The AU only needs to have one signed Parent Consent Form on file in their district for the length of time that student is enrolled in the same district. Parents can opt out at any time, but it is necessary to have the current version of the form completed. If a student has a change of placement to a new Colorado school district, a new Parent Consent Form should be signed and submitted.

Parent Consent Form in English

Parent Consent Form in Spanish

The MDB/FDB Form is not needed for all registered students.

The MDB/FDB Form is an optional document used to verify legal blindness for school-aged students to be entered in the federal quota census count. It is particularly helpful when an eye report does not specifically mention that the student Meets or Functions at the Definition of Blindness. It is to be signed by the student's Ophthalmologist or Optometrist and is based on the date of the student's last eye exam (also known as the encounter date) and not the date the form is signed.

MDB-FDB Form

Exit Forms:

Exit Form in Word format

Use this Exit Form in plain text format if you are using screen reading software

 

 

Guidance Documents for Statewide Registration Database & Federal Quota Census paperwork:

If you would like a copy of the Statewide Registration Database sample report, email CIMC and we will send a copy.

January 2021 count day instructions

January 2021 cover sheet for Statewide Student Registration Database & Federal Quota Census

CIMC legal blindness guidance document

 

 

American Printing House for the Blind Instructional Products

CIMC APH Order Form

Use  the order form below for most instructional products manufactured by APH. Exceptions are APH products that fall under the categories of braillers, technology (such as talking calculators, the Chameleon 20, or Mantis Q40), electronic downloads (such as the "CVI Complexity Sequences eBook and Interactive Cards") or software (such as Talking Typer, or a JAWS or ZoomText annual student license). See the "Brailler, Technology, and Software" section below to order these products.

CIMC APH Order Form for 2020-2021 (Word format)

Screen reading software users can access this plain text version of the CIMC APH Order Form for 2020-2021

 

 

APH Resources

APH website

APH Monthly Newsletter

2020 APH Annual Meeting videos archived (YouTube)

#AtHomeWithAPH Resources webpage

APH's new Access Academy (formerly #AtHomeWithAPH) is your one-stop resource for the meaningful education and training webinars you need to get the most out of APH products and services. From tutorials on new products and hacks on how to get the most from your beloved tech, to information on resources, services, and programs: APH's goals is to give you the information you need for home, the classroom, and the workplace.

APH Access Academy webpage

APH's YouTube Playlists by Product

APH HIVE

BrailleBlaster is a braille transcription program developed by the American Printing House for the Blind. Download this software at no-cost using the link below

BrailleBlaster

BrailleBlaster Playlist on YouTube

Tactile Graphic Image Library: Need a tactile map, graph, or diagram for class? Sign up at the link below to create your free account with APH. Download or request your needed tactile map, graph, or diagram by using APH's free online Tactile Graphics Image Library (TGIL). Vector images are available in PDF format, along with .png and .stl files. Before class starts, have your graphic ready to go by downloading and embossing it or using it with swell paper or with a 3D printer (.stl files only). 

Tactile Graphic Image Library

APH Downloadable Product Manuals page: The APH product manuals listed are free-of-charge downloads. You may print or emboss them as needed, in most cases. Please note: manuals on these download pages may be available from APH in other formats that are not shown; for example, the braille manual for a kit may be available for free download, but the large print manual may only be available for purchase and will therefore not appear on this download page.

APH Downloadable Product Manuals

 

 

LEGO Braille Bricks

LEGO Braille Bricks were created by the LEGO Foundation as an educational tool to help children who are learning braille. APH is the U.S. distributor for LEGO Braille Bricks, a product that is being provided, for free, by the LEGO Foundation. The bricks are not available for parents or general consumers to order. By distributing them to schools and educators, students coming in and out of the classroom will have access, and the kits will be available to children for years to come.

When the Ex Officio Trustee of a quota account orders the bricks, the following LEGO Braille Bricks Terms of Use is signed:

"LEGO Braille Bricks are to stay in the possession of the defined "User Group", meaning private or public schools, institutes, education centers, etc. in the Territory where one or more blind or visually impaired children receive education and support, including in respect of the Braille system, as well as professional individuals associated with or operating at such schools, institutions, education centers, etc. in connection with such education and support to blind and/or visually impaired children.

"User Group" does not comprise any other private or public legal entities, institutions, organizations, etc. or other individuals, such as parents of blind or visually impaired children, or blind or visually impaired children themselves.

LEGO Braille Bricks will be delivered to the member of the User Group exclusively for its own use in the education and support to blind and/or visually impaired children and that the member is not entitled to sell, lend out or give away any LEGO Braille Bricks to anyone not part of the User Group.

LEGO Braille Bricks are to be used by children ages four (4) and up. Due to choking hazards this product is not to be used with children younger than three (3) years."

Read First: Procedure for school districts to order LEGO Braille Bricks

Pre-filled LEGO APH Order Form

Pre-filled LEGO CIMC Professional Lending Library Order Form

LEGO Braille Brick Resources:

LEGO Braille Bricks webpage

APH's archived LEGO Braille Bricks videos can be found here

LEGO Braille Bricks webinars for November & December 2020 (PDF flyer)

 

 

 

The InSights Art Contest is now open!

Click on the link below for the 2021 application. APH is currently accepting entries now through March 26, 2021. Additional information can be found on the InSights Art Contest website.

InSights Art Application

Braillers, Technology, and Software

Use this "Brailler, Technology, Software Order Form" when ordering the following products.

Braillers:

  • Perkins Classic brailler (from brailler.perkins.org)
  • APH SMART Brailler by Perkins
  • APH Light-Touch Perkins Brailler

Software and digital downloads from APH:

  • CVI Complexity Sequences eBook and Interactive Cards
  • JAWS (Job Access with Speech) Suite license (if a first year suite license was purchases prior to September 2019), or an annual student subscription 
  • ZoomText Suite licenses (if a first year suite license was purchase prior to September 2019), or an annual student subscription
  • Armadillo Army (digital download)
  • Book Wizard Reader (digital download)
  • Book Wizard Producer (digital download)
  • Learn Keys: Verbal Keyboard Feedback Software (digital download)
  • Math Flash Software (digital download)
  • Money Talks Software (digital download)
  • O&M Family Booklet Software (digital download)
  • Talking Typer (digital download)
  • Talking Typer (for iOS devices)
  • Talking Word Puzzles (digital download)
  • Teacher's Pet Software (digital download)
  • Termite Torpedo (digital download)
  • Toodle Tiles: Emmy's Town (digital download)

Technology:

  • BookPort Plus desktop
  • Braille Trail Reader LE
  • Chameleon 20
  • Mantis Q40
  • MATT Connect (see the pre-filled out order form link below)
  • Orbit Reader 20
  • Orion TI-30XS MultiView Talking Scientific Calculator
  • Orion TI-84 Plus Talking Graphing Calculator
  • VideoMag HD - Orders must be related to a prescription from the CSDB/CDE Colorado Low Vision Evaluation Clinic (CLVEC)
  • Juno video magnifier - This product is expected to be released in early 2021. Orders, if filled using quota funds, will likely also need to be related to a prescription from the CSDB/CDE Colorado Low Vision Evaluation Clinic (CLVEC)
  • (Jupiter portable desktop video magnifier: The CDE/CIMC has not made the decision to use our limited quota funds to purchase this product at this time)

 

A Director of Special Education (or designee) signature is required for brailler and technology orders, but not for software orders. Electronic signatures are acceptable during this time of COVID-19 and remote/distant learning

Use this accessible fillable PDF form to complete the "Brailler Technology Software Order Form" on your computer

MATT Connect Order Form (pre-filled)

Teacher Resource: APH MATT Connect Skills Checklist to use with students

CIMC Brailler Repair Form

Resources

This document below was revised on October 23, 2020. Check back for updates.

CIMC Resources document to share with Colorado TVIs

 

 

 

Contact Us:

Email: cimcaphorders@csdb.org - Use for "APH order form" & "CIMC Professional Lending Library" submissions and related questions.

Email: cimcbookorders@csdb.org - Use for braille and large print "Book Order Form" submissions, sourcing inquiries, and questions.

Email: cimcBraillerTechSoftware@csdb.org - Use for "Brailler, Technology, & Software" order form and the "brailler repair form" submissions and questions.

Email: cimcregistrations@csdb.org - Use for questions and to submit "registration" and "exit" forms and questions about your district's statewide VIIB registration database report and the Federal Quota Census.

(719) 578-2196 - CIMC Pilot Phone number. This will ring all of the CIMC computer-based Skype for business phones simultaneously but this pilot number does not have a voicemail message capability.

Mailing Address: CIMC, 1015 East High Street, Colorado Springs, CO 80903-3559