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Requesting Eyeglasses


NWLERC provides glasses to qualified organizations based on the order in which applications are received. We normally require eye care professionals to accompany missions we support. We want to encourage groups to request eyeglasses from us as far in advance as possible. This allows us to more effectively schedule and utilize our network of volunteers to provide you a quality product. We will notify you, as soon as possible, if we can support your mission request.

NWLERC is currently unable to pay to ship glasses to you, but we will do everything possible to help get the glasses to you.

To request a full application, simply complete the following online form and an application will be emailed to you. If you prefer the application to be mailed, please indicate in the comments block.

Please note: NWLERC is unable to provide glasses to individuals in the United States due to state laws.


Request For Application Package


Group Name:

Point of Contact’s Name:

Mailing Address:

Phone Number:

Fax:

Contact E-mail Address:

Dates of Mission:

Date Glasses Needed By:

Number of Glasses needed:

Location of Mission (City and Country):

Comments or Notes: