Referral Application



Whether you prefer to complete our Referral Application 

online or on paper, we've got you covered. 

Online Application:

Our online form will require you to create a site membership. This will allow you to save your progress and submit only when the application is complete.

Paper Application:

If you prefer paper, Our application pdf is downloadable right here.

Completed paper applications should be delivered by email to

or mailed to:


The Mayhew Program

PO Box 120

Bristol, NH 03222

Any questions, please call Sally Sheffield at (603) 744-6131