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Georgia Vision Programs
Star Pupils Children’s Program

Children’s Vision Screening Forms

If your school is already scheduled for a screening and you are unable to receive or download forms sent to your email address, you may select and print the necessary forms below.

Information Memos

Provides overall preparation instructions for the scheduled vision screening:

Permission not required

Permission required

Permission Letters

Permission not required – child will be screened unless parent says “no”:


Permission required – child will not be screened unless permission letter is returned:


Additional Forms and Resources

Registration Form

Download to print names of children to be screened on the registration form before the Prevent Blindness Georgia screener arrives.

Lea Symbols Chart

Download to practice with children in advance of a scheduled vision screening.

Form 3300/EED

Download only if needed for children who have not had vision screening required for school entry.

Your Child Failed the Form 3300 Vision Screening Flyer – English

Your Child Failed the Form 3300 Vision Screening Flyer – Spanish

Download to distribute educational information to families of children who fail the Form 3300 vision screening.

Georgia’s Voice 4 Vision Newsletter

Download this educational newsletter to send home to all parents of all screened children.