All fields required unless otherwise noted.

Mailing Address

Practice/Organization Information

All fields required unless otherwise noted.

*Charitable, community-based, or educational events not related to disaster relief or vision care outreach considered on a case-by-case basis as our schedule permits.

A brief description of your event: Who will be helped, event details and event purpose, any additional organizations participating.

Event Start Date and Time

Events with less than three months notice will be declined. One-day events of seven or more hours and multi-day events will be given priority.

Event End Date and Time

All Fields are required unless noted.

*_Eligibility:

• _{Family income up to 200% of the federal poverty level guidelines for your family’s size}
• _{Haven’t received eye care through a VSP program during the last 12 months Eye care services and prescription eyewear are not available if already covered through a private insurer and/or a government program. All services are offered on a first-come, first-served basis.}