Make a Referral

Making a referral to DGCKids can be the first step toward a brighter future for a child who is blind or has a visual impairment.

DGCKids Referral Form

After you complete this Referral Form, a Referral Coordinator will contact the parent/guardian to talk through the next steps. We’re here to answer questions and provide support throughout the process.

"*" indicates required fields

Parent/Guardian Name

First Last

Phone

Why You're Referring

This helps our team understand how to best connect the child and family with services and support.

Who is Referring?*

Additional Contact Information

Please include your name, organization, and contact information in case follow up is needed.