Referral Application



Whether you prefer to complete our Referral Application 

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



Please read this important message from our Program Director, Greg Stoutzenberger.

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