Apply to Listen using a Radio

Qualified individuals within the Greater Richmond area that do not have internet service or are unable to use an internet-enabled device should apply to listen using a Virginia Voice radio.

  • Please apply by completing this form. Fields marked with an asterisk (*) are required. When you are finished, please click the SUBMIT button at the bottom of the form to send it to Virginia Voice and someone from our office will contact you. Thank you applying for our service.
  • Phone number of person completing application.
  • Email address of person completing application.
  • NEW LISTENER INFORMATION

  • (Ex: Mr./Mrs./Ms./Miss, Dr./Rev.)
  • Address must include the name of the residential facility and any room, apartment or unit number, if applicable.
  • Enter "Deceased" if widowed
    Enter name under which phone is listed when using "Other"
  • ELIGIBILITY

    Virginia Voice services are intended for the use of individuals who are unable to read for themselves due to a vision impairment, or a disability that prevents them from holding printed matter.
  • The above-named applicant is eligible for a Virginia Voice radio for the following reason(s):
  • Please provide diagnosis or details of health condition and/or disability.
  • Listener Primary Contact (Required)

  • (Ex: Mr./Mrs./Ms./Miss/Dr./Rev.)
  • Name of primary contact for the applicant.
  • Only if relevant
  • Please enter complete address for primary contact
  • Listener Second Contact (Desired)

  • (Ex: Mr./Mrs./Ms./Miss/Dr./Rev.)
  • Only if relevant
  • If you have any questions, please contact officemgr@virginiavoice.org
Default General Message Type
Default Error Message Type
Default Success Message Type
Default Notice Message Type

Customization Settings

The shortcode options allow you to set background colors, accent colors (text/icon), border size and color, and display a bottom shadow.

Fully Customizable Settings!
Customize The Background Color
Customize The Accent Colors
Control The Border Size
Control The Border Color
Subtle Box Shadow Setting
Fully Customizable Settings!
Customize The Background Color
Customize The Accent Colors
Control The Border Size
Control The Border Color
Subtle Box Shadow Setting

Animation Settings

Alert boxes can have CSS3 animations. This allow the box to animate when it comes into the viewport to helps catch the viewers eye.

Bounce Animation Setting
Slide Animation Setting
Flash Animation Setting
Shake Animation Setting