2501 W. 18th Ave., Suite D
Emporia, KS 66801
620-342-1714 • Fax 620-342-4701
The cost of an eye exam and up to $175.00 will be considered for glasses or contacts (if currently wearing) provided there is no other vision plan/insurance coverage. Jones Foundation must pre-approve all services, and will not reimburse for any costs paid prior to application.
Application for this grant is limited to once a year and can be made for multiple children in the household. If previously awarded, application must be made at least one year from time of last authorization.
Seeking assistance for paying the costs associated with both the exam and glasses?
Complete and return the Grant Application for Eye Care to the office at least 5 business days prior to your child’s appointment for the director’s review.
Seeking assistance for paying only the costs associated with glasses or contacts?
Complete and return the Grant Application for Eye Care to the office PRIOR to ordering.
The Jones Foundation will not pay co-pays nor balances after insurance for eye exams. Additionally, should a vision plan/insurance pay more than our allowed amount of $175.00 for glasses/contacts, the Foundation will not pay the balance remaining.
If your total monthly household income does not exceed the amounts below, you may be eligible to receive a grant. Complete the Grant Application for Eye Care here for each child needing assistance. Once completed, print and return to our office with the following REQUIRED documents:
- Copies of all paystubs received in the past 30 days prior to date of application and proof of all other monthly income.
- State Issued Birth Certificate for each child needing assistance
|Size of Total Household||Maximum Monthly Income|
|Family of 1||$2,147.00|
|Family of 2||$2,903.00|
|Family of 3||$3,660.00|
|Family of 4||$4,417.00|
|Family of 5||$5,173.00|
|Family of 6||$5,930.00|
|Family of 7||$6,687.00|
|Family of 8||$7,433.00|
Please note that the guidelines above are unique to this program only and are updated annually.