Apply for a MIRA Guide Dog

Please Read - MIRA USA accepts applications beginning with a child's 9th birthday. We begin the process of pairing children with guide dogs at the age of 11 and serve children up until the age of 16. 

Contact Information

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Address
City
Email*
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Applicant Information

Please feel free to elaborate.

Child's First & Last Name
Child's Date of Birth
Degree of Visual Impairment Left Eye
Degree of Visual Impairment Right Eye
How long has your child been blind?
Cause of Blindness?
Use a white cane? At home, school, or both?
Regularly work with an Orientation & Mobility instructor? How often? For how many years?
How are their skills at street crossings? Please elaborate.
Does your child have additional complications other than blindness?
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