Eyewear Donations Form

All fields are required unless noted.

Your Information

Name

Title

Email

Phone

Organization/Practice Name

Website

Street Address within the U.S.

City

State

Zip Code

Tax ID/Employer Identification Number (EIN)

Is your organization recognized as a 501(c)(3) charitable organization?

Yes No Not sure

Event Details

Who will prescribe and/or dispense the eyewear requested?

Optometrist Ophthalmologist Other

If other, please specify

Describe how the eyewear requested will be used on your mission trip or during outreach.

In what country/countries will the requested eyewear be distributed?

When do you need the requested eyewear to be delivered?

When will the requested eyewear be distributed?

Eyewear Needs

What type of eyewear are you requesting for donation? Select all that apply.

If you're requesting readers, as of December 2024, we’ve reached our capacity and are pausing orders. Please check back in early 2025.

New Optical Frames: Must be provided at no cost to the patient. New Sunglasses: Must be used for eye health-related outreach and provided at no cost to the patient. New Readers (Unisex Plastic Frames): Must be used for disaster response or eye health-related outreach and provided at no cost to the patient.

You indicated your organization would like to receive New Optical Frames. Please select the type and quantity.

Enter Quantity of Men's

Enter Quantity of Women's

Enter Quantity of Children's

You indicated your organization would like to receive Sunglasses. Please select the type and quantity. Children’s sunglasses are not available.

Enter Quantity of Men's

Enter Quantity of Women's

You indicated your organization would like to receive Readers.

Readers are available as a box of 25 unisex readers in powers of +1.50, +2.00, +2.50, and +3.00. Due to limited supplies, qualifying organizations may request one box every 12 months.

Submit

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Request Eyewear Donations