•  We collect used eyeglasses to share with others in need.  If you have eyeglasses that you would like to donate, please contact any club member.   

Eyeglass drop off locations

  • Palmerton High School


Scroll Down






Eyeglass Assistance

With monies raised through the support of our community, Palmerton Lions Club is able to offer financial assistance to persons in need of eyeglasses.  Determination is made based on a physician's referral and completion of a brief questionnaire.  For information or an application, please contact:

  • James Sheckler at 610.826.4533
  • Steve Oreovec at 610.826.8251
  • Claire Heiny at 610.826.4978

Palmerton Lions Club Eyeglass Policy and Financial Application 

Policy Title:                           Eyeglass funding                                                                                                                                                               

Policy Drafted:                     February 12, 2012


Drafted by:                           Eyeglass committee


Date Approved:                   February 20, 2012




The board of directors will authorize the formation of an eyeglass committee whose responsibility will be to establish a policy & request form for funding and make recommendations to the board of directors and the membership regarding the granting of funds to purchase eyeglasses for individuals with financial need. 


The individual with financial need will contact a member of the committee. 

The committee member will provide requestor with an application.

The application will be completed in its entirety by the requestor and will be given to/mailed to the club. 

If the application is incomplete, it will be returned to requestor by the committee and will not be re-evaluated until it is considered acceptable. 

The eyeglass committee will review the application for need and will make a recommendation to the board of directors and the membership and will note this on the application.   

Following approval a member of the committee will contact the requestor with the club’s response.  The committee reserves the right to ask questions related to the need for eyeglasses and/or funding and also reserves the right to deny a request. 

If the decision is made to provide funding, it will be provided directly to the business where the eyeglasses are to be purchased.

The requestor is responsible for making all appointments and transportation arrangements.  The club will not assume this responsibility. 

A receipt for purchase will be required from the requestor or the business where the eyeglasses are to be purchased. 

All requests must be made and approved in advance.   Retroactive requests will not be considered.

Funding will only cover eyeglasses and will not cover eye examinations, designer frames, tinting, contact lenses, LASIK surgery, etc.

Funding will only be provided to residents of Palmerton area. 

If having cataract surgery, eyeglasses will not be funded until after the requestor has surgery and physician determines that correctives lenses are appropriate. 

Each applicant will receive a maximum up to $150.00 for eyeglasses. 

Palmerton Lions Club

Eyeglass Funding Application

Applicant     □Adult      □Minor    (√ one)


Date of application________________________________________  DOB of applicant______________


Name______________________(Last)     ______________________(First)     _________(Middle initial)





Telephone (          )________________________     Email address_______________________________


Date of Appointment with eye doctor______________________________________________________


Name of eye doctor___________________________________________________________________


Address of eye doctor_________________________________________________________________



Are you scheduled for cataract surgery within the next year?  □Yes     □No


Reason for funding request (Use separate sheet if necessary, but please be brief)




Are you currently working?   □Yes     □No     If no, explain__________________________________


If yes, occupation _______________________  Employer_________________________________


Is anyone in your household working?   □Yes     □No  If no, explain___________________________


What is your annual household income?  $__________________________________________ annually

Include Social Security, SSI, Pension, Veteran’s benefits, retirement, Life insurance premiums, Public Assistance/Welfare, Child Support &/or unemployment compensation.

Total number residing in your household_____________

The maximum funding available for eyeglasses is up to $150.00.  Do you have the remaining funds to pay for your eyeglasses?  □Yes     □No

If no, how do you anticipate obtaining the remainder of the funding?  ______________________________

Do you have funds to pay for your eye examination?  □Yes     □No                        

If no, how do you anticipate obtaining the funding to do so?  ____________________________________

__________________________________________________________________________________  OVER>>>>>>>>>                                                                                                                                            

Eyeglass Funding Application – Page 2


Name of applicant _______________________________________________________


Monthly expenditures

Mortgage/Rent     $__________     

Food                       $__________

Heating                  $__________

Cable                     $__________

Water/sewer          $__________

Garbage                 $__________

Clothing                 $__________

Auto loan/lease    $__________     

Other (specify)     $__________  List additional expenses______________________________________

TOTAL                 $__________


How did you find out about our eyeglass program?  _________________________________________



Although this is not a stipulation for you to obtain funding, are you willing to assist with any of our club’s service projects?  □Yes     □No


By signing below, I verify that all information I have provided on this application is accurate.  In addition, I grant the Lehighton Area Lioness Lions Club permission to verify the accuracy of the data.  I understand that if any inaccuracies are found, that the agreement for funding, if provided, will be withdrawn.  I further agree to provide a copy of the receipt for my eyeglasses to the Palmerton Lions within 2 weeks of receipt of the eyeglasses. 



____________________________________________________     _____________________________

Signature of applicant or Legal representative                                         Date                                                             


Please mail completed application to:


Attn:  Eyeglass Committee

          Palmerton Lions Club

          Palmerton PA 18071


Please do not write below this space



Official Use Only


□Funding denied by committee                 □Funding approved by committee


□Funding denied by BOD/membership     □Funding approved by BOD/membership


Amount approved $_________________     Check #________________  Date__________


Committee members’ signatures


___________________________________                ___________________________________

___________________________________                 ___________________________________

___________________________________                ____________________________________









Lions Clubs International News
Connect with Us Online