This page is for organizations that have already established a collaboration with Ray Of Hope and have been approved to submit referrals to our Children's Medical Assistance Program

Please contact Ray of Hope if you wish to be approved to refer children at 260-416-2116

Step 1: The Medical Assistance Application is required by the hospitals and must be filled out completely before they will review the case.  To ensure accuracy a family member will be needed to help answer the questions.  This form is needed for every referral​

Medical Assistance Application (completed for every referral)

Step 2:  The Physician Referral Request must be printed, signed and emailed to  You must also include 3 recent photos (facial, full body, close up of referred illness) and the original medical report with translation.  ROH will not present cases to physicians/hospitals until these have been received. 

Physician Referral Request

Step 3:  Once the Child has been approved for care, you may request funds by filling out the Request for Funds Form (below)  All funds requested will be verified for accuracy, do not over estimate funds needed.

Request for Funds

Step 4:  Once funds are received medical tests should be arranged and a passport should be obtained.  Prior to the Visa appointment ROH will complete the following forms and email them to you.  It will be neccessary for some of the forms to be signed by parents/guardians and notorized.  After the forms are signed and notorized they must be emailed to ROH at prior to any travel arrangements being made.  The original forms must travel with the child and escort to the USA and given to the ROH representative at the airport.

Ray of Hope Visa Request Primary Physician Commitment Letter Hospital Commitment Letter Host Family Letter Escort Request Letter Parents Authorization of Treatment & Special POA

Step 5:  Once all paperwork is completed, please make a visa appointment, once the visa is approved ROH will make travel arrangments for the escort and child to travel to the USA.  In most cases travel will occur within 5-10 days after the Visa is granted.